BACKGROUND The effect of surgery on the level of the inframammary crease, a long-standing landmark in cosmetic breast surgery, has not been previously investigated. There has been speculation that breast augmentation may lower this level and that vertical mastopexy may raise it, but no confirmation of these opinions has been published. OBJECTIVES The author measured the preoperative and postoperative levels of the inframammmary crease in an effort to document the movement of the crease after four types of cosmetic breast surgery. METHODS The inframammary crease level was measured prospectively in 40 consecutive cosmetic breast surgery patients who presented to the author's clinic for breast augmentation, mastopexy, augmentation mastopexy, or breast reduction. The vertical mastopexy and reduction technique was implemented in all patients. The Canfield Mirror 7.1.1 imaging system (Canfield Scientific, Fairfield, New Jersey) was utilized for calibration, standardization, and orientation-matching of photographs, and for measurements of crease level. The single-sample t test was utilized to compare the changes in the level of the inframammary crease, where a P-value < .05 was considered significant. RESULTS The level of the inframammary crease was significantly lowered by breast augmentation and significantly elevated by vertical mastopexy or breast reduction. Augmentation mastopexy resulted in either lowering or raising of the crease level, and no change in one patient. CONCLUSIONS The level of the inframammary crease is dynamic; it typically descends after breast augmentation and is raised by a vertical mastopexy or reduction. Therefore, the lower pole is recommended as an alternative (and more static) landmark.