A Novel Approach to Breast Ptosis in Reduction Mammoplasty: Outcomes of the Paisley Pattern Incision

<b>Introduction:</b> Breast reduction mammoplasty incision patterns vary in benefits and drawbacks. The Wise pattern enables lateral skin resection but leaves medial and lateral scars, while the Vertical pattern yields a smaller scar yet limits lateral skin removal. A novel, Paisley pattern allows lateral skin resection without a medial scar. This study compares postoperative outcomes of the various techniques. <b>Methods:</b> A retrospective chart review of 118 patients undergoing bilateral breast reduction mammoplasty from January 2020 to November 2024 at a single institution was performed. Demographics, comorbidities, operative details, and 60-day complications were collected. Analyses included chi-squared tests, ANOVA, and <i>t</i>-tests. <b>Results:</b> Of 118 patients, 60 (51%) underwent Wise, 44 (37%) Vertical, and 14 (12%) Paisley reductions. The Paisley group had the highest BMI (35.5 ± 5.5), significantly higher than Vertical (31.3 ± 4.4, <i>P</i> = .005) but not Wise (33.8 ± 4.6, <i>P</i> = .204). Operative time was shortest for Paisley (2.47 ± 0.41 h) versus Vertical (3.05 ± 1.06 h) and Wise (4.71 ± 1.97 h), significant between Paisley and Wise (<i>P</i> < .001) and Wise and Vertical (<i>P</i> < .001). Paisley had the highest resection volume (2026.9 ± 780.6 g), greater than Vertical (1137.3 ± 624.7 g, <i>P</i> = .03) and comparable to Wise (1860.1 ± 866.1 g, <i>P</i> = .423). Complication rates were 36.4% Vertical, 21.4% Paisley, and 14.8% Wise; no Paisley patients required revision surgery. <b>Conclusions:</b> The Paisley pattern offers comparable complication and reoperation rates, shorter operative time, and greater resection volume, with technical and aesthetic benefits.