Abstract
One of the most important and challenging decisions in reduction mammaplasty and mastopexy is the choice of incision. Although an existing algorithm considers the sternal notch-nipple distance, patient age, and skin quality to guide selection, it remains incomplete. The superior breast border-inframammary fold distance provides a more accurate assessment of the actual amount of skin and tissue. By analyzing this measurement-along with its components and the patient's skin quality-we can determine the optimal incision type using the mathematics of distances and breast geometry. In brief, a superior breast border-inframammary fold distance of up to approximately 32 cm is generally suitable for a vertical scar mammaplasty.