Objective To investigate the clinical application of vertical incision internal pedicle in mastectomy for hypertrophy. Methods From March 2020 to March 2023, 45 cases of breast hypertrophy were corrected by vertical incision, and the new nipple position, the new areola diameter and the width of the inner and upper dermal gland pedicle were individually designed. The inner and upper pedicle were de-epidermis, the skin and subcutaneous tissue in the "C" shaped area were excised, and the deep tissue of the outer and upper skin coverings were personalized with the safe skin mask thickness of 2.0 cm retained. Proper pedicle trimming was conducive to rotation and shaping, the old and new lower fold areas were thinned, and the cosmetic suture technique was applied to reshape the breast shape. Results A total of 45 cases (90 breasts), the degree of elevation was 3.0 to 15.5 cm, the weight of the removed unilateral glands was 380 to 2300 g, 5 cases suffered from fat liquefaction and poor incision healing after surgery, healing after dressing change, good blood flow to the nipple and areola, 3 to 12 months after the operation, physical discomfort symptoms improved significantly, nipple feeling good. Patients were satisfied with breast size, shape and scar status after surgery. Conclusion The application of vertical incision in the upper pedicle method to correct hypertrophy and ptosis of the breast, with safe blood supply to the pedicle, personalized operation, full removal of redundant tissue, hidden postoperative scar, full and symmetrical breast appearance, can achieve desired satisfactory results for some mild, all moderate and most severe patients with breast hypertrophy and ptosis. [ABSTRACT FROM AUTHOR]