**5.2 Wise pattern/inverted T**

This is the most commonly used mastopexy and reduction pattern in the United States and is similarly very popular when combined with augmentation. This can be based on multiple pedicles, with the inferior pedicle being the most preferred historically. However, other pedicles have gained popularity in recent years, particularly superior and medial pedicles. Although related, the skin excision pattern and glandular pedicle are separate components and each component should be selected based on thoughtful surgical planning. The horizontal component on the Inverted T incision is very beneficial in controlled the Nipple to Inframammary fold (N-IMF) distance in patients who have N-IMF distances much greater than 8–10 cm prior to surgery. It can be used with most pedicles and ptosis situations.

## **5.3 Vertical mastopexy/teardrop**

 Popularized by Lassus and LeJour and later modified by Findlay-Hall, the vertical mammoplasty traditionally seeks to avoid the horizontal scar relying on gathering excess inferior skin during closure and additional volume reduction is aided by liposuction inferiorly and laterally. Unfortunately, final breast shape can take many months to achieve and may still require skin excision inferiorly if puckering persists. The advantages that this technique offers are less incisional scarring, good projection, and this technique allows a versatile pedicle design. We feel the Superomedial-Central (SMC) pedicle is the most predictable and versatile pedicle due to more robust blood supply and venous drainage and this pedicle works very well with a vertical or inverted T mastopexy.
