A wise pattern breast reduction combines the vertical breast lift (periareolar incision with midline vertical incision) and adds an incision in the inframammary fold (IMF). The IMF incision helps to remove excess skin and shorten the difference between the nipple and the fold. While this incision is the longest, it is also the most powerful in terms of skin removal and control of shape. In my opinion, the IMF incision is the least consequential of the three incisions as it hides very well in the fold underneath the breast. That being said, once a vertical incision is needed, the addition of an IMF incision should not dissuade a patient from this procedure or from a specific surgeon.