Mastopexy Techniques — A Patient's Guide
"Which technique will you use on me?" is one of the most common — and most important — questions patients ask. The honest answer is: it depends on your anatomy. This guide explains the main mastopexy techniques in plain English, what each achieves, and when each is appropriate. You don't need to memorise the terminology, but understanding the landscape helps you have a more informed conversation at consultation.
Three decisions, not one
Every breast lift involves three distinct technical choices that are often bundled together:
- The scar pattern — the shape of the incisions on the skin, matched to your ptosis grade.
- The pedicle — which part of the breast carries the nipple's blood supply and nerves.
- With or without an implant — whether volume restoration is needed alongside reshaping.
These are independent decisions. You can combine a superomedial pedicle with a vertical scar and a round implant, for example. Some combinations are more common than others because they suit specific anatomical patterns.
Scar patterns — matched to your ptosis grade
Periareolar (donut / Benelli) — Grade 1
A single scar around the areola only. The shortest scar pattern possible, with the areolar edge as the entire operative access. Only suitable for mild ptosis (grade 1) where the skin has good elasticity and the nipple needs to be lifted by 1–2 cm at most. It can also be used to reduce an enlarged areola at the same time.
Best for: grade 1 ptosis, minor areolar reduction, patients who prioritise the shortest scar and accept its limitations.
Trade-off: may flatten upper-pole projection over time; not suitable for anything beyond mild ptosis.
Vertical (lollipop / Lejour) — Grade 2
The scar circles the areola and runs vertically down to the fold — no long horizontal line. Produces a shorter total scar that usually matures to a fine pale line within 12–18 months. The workhorse technique for grade 2 (moderate) ptosis with good skin elasticity. Initial appearance at 2–6 weeks can look "puckered" at the lower pole; this resolves as skin settles.
Best for: grade 2 ptosis, younger patients with good skin elasticity, patients who want the shortest scar compatible with a real lift.
Trade-off: slightly longer settling time than Wise pattern.
Wise pattern (anchor / inverted-T) — Grade 3
The classic lift scar. It runs around the areola, vertically down to the fold, and horizontally along the fold — like an anchor or upside-down T. Gives the surgeon maximum control over shape and is suitable for severe ptosis (grade 3) and significant skin excess. Trade-off: the horizontal scar is longer, though it sits inside the breast fold and is invisible in most bras and swimwear.
Best for: grade 3 ptosis, significant skin excess, poor skin elasticity, patients for whom shape reliability is more important than scar length.
Pedicle techniques — nipple blood supply and sensation
The pedicle is the "bridge" of tissue that keeps the nipple alive and sensate while the surrounding skin and tissue are rearranged. Pedicle choice is made by your surgeon based on anatomy, the direction the nipple needs to move, and the scar pattern selected.
Superior & superomedial pedicles
The most common pedicles in mastopexy — the nipple is carried on a pedicle from directly above or from the upper-inner breast. They pair elegantly with vertical and Wise scar patterns, produce reliable upper-pole fullness, and preserve nipple sensation and breastfeeding potential.
Inferior pedicle
The nipple stays attached to tissue rising from below. More commonly used in reduction than in pure lift, but useful in specific mastopexy cases with very long nipple-to-fold distances. Robust nipple blood supply; strong breastfeeding preservation.
Autologous mastopexy vs augmentation-mastopexy
This is the most important decision besides scar pattern. It is a volume question, not a shape question.
Autologous mastopexy (no implants)
If you have enough breast tissue and your concern is purely shape — sagging, low nipple position, flattened lower pole — an autologous lift is enough. The existing tissue is redraped on a new pedicle, the nipple is repositioned, and excess skin is removed. No implant means no long-term implant-related risk (capsular contracture, rupture, replacement), and no implant cost.
Best for: good volume with sagging; patients who want a pure reshaping operation with no implants.
Augmentation-mastopexy (lift + implants)
When volume has been lost — typically after pregnancy, breastfeeding or significant weight loss — a lift alone produces a lifted but deflated breast. Adding an implant restores upper-pole fullness and overall volume. The lift and augmentation are performed in the same operation; both the scar pattern and the implant are selected together.
Best for: deflated post-pregnancy or post-weight-loss breasts, patients seeking restored volume alongside a lift.
Round vs anatomical implants in augmentation-mastopexy
When an implant is added to a lift, the shape of the implant matters more than in a pure augmentation — because the breast tissue around it is being newly arranged.
Round implants — preferred in most cases
Round implants provide upper-pole fullness and predictable behaviour with a lifted breast. Their shape is rotation-independent — if the implant moves inside the pocket, the breast shape doesn't change. This is especially relevant in mastopexy, where internal tissue rearrangement can create subtle rotational forces. For most augmentation-mastopexy cases, a round implant with appropriate profile (moderate to high) is the safest and most predictable choice.
Anatomical implants — in selected mild-ptosis cases
Anatomical (teardrop) implants mimic the natural shape of the breast, with more projection at the lower pole. In selected cases of mild ptosis — particularly where the goal is a very natural-looking lower-pole curve without obvious upper-pole fullness — anatomical implants can be considered. Trade-off: they are shape-dependent, so rotation inside the pocket can alter the breast shape; textured surfaces are typically used to reduce rotation risk.
How does Dr. Erdal decide?
Three factors guide the plan for every patient:
- Ptosis grade — determines the scar pattern (periareolar → vertical → Wise).
- Volume status — determines autologous vs augmentation-mastopexy.
- Skin and tissue quality — fine-tunes pedicle choice, implant shape and internal support.
In practice, vertical (Lejour) and Wise pattern are the two most frequently performed incision patterns in Dr. Erdal's lift cases, most often with a superior or superomedial pedicle. Round implants are used in the majority of augmentation-mastopexy cases; anatomical implants are reserved for selected mild-ptosis cases with specific lower-pole goals.
Which technique suits your anatomy?
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