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Differences Between Breast Reduction Techniques?

For Breast Reduction surgery, what are the differences in types of surgery? What are the differences between "Wise pattern", "anchor scar" versus "vertical" or "keyhole scar?"

Can Liposuction of breast be used in conjuction with Breast Reduction surgery to reshape breasts?

Doctor Answers 9

Vertical breast reduction better for most women.


In New York City, we use the vertical or lollipop scar breast reduction for most women (unless the breasts are really huge). It shapes the breasts internally and gives much better long term results, as well as less scarring. And we do use liposuction as part of the breast reduction.

Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

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Breast reduction incisions, techniques and scars: Confusing names explained

Wise Pattern = Lexer = Inverted T = Anchor Scar = Verical & Horizontal = Keyhole Scar all describe a technique with a scar around the areola with a vertical scar extending downwards to a horizontal scar in the breast crease (underwire area)


Vertical = Hall-Findlay = Lejour = Circumvertical = Lollipop = Tennis Racket. all describe a technique with a scar around the areola with a vertical scar extending downwards.

The choice depends on the extent of ptosis (sagging) and the surgeon's experience.

Liposuction is commonly used with the Vertical techniques and less freqeuntly withthe Vertical/Horizontal techniques.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 54 reviews

Breast Reduction technique differences

Essentially, there are now four techniques utilized for breast reduction. Within these four basic types of procedures, there are multiple variations. The main types of procedures are:

1) The Wise pattern or anchor incision that puts an incision around the areola then down to the inframammary crease and along under the crease;

2) The Vertical (or “Lollipop” or “Keyhole”) which eliminates the inferior inframammary incision;

3) The transverse that uses only the inframammary and periareolar incisions; and

4) Liposuction alone.

In the vertical procedure, although the intent is not to use an inframammary incision, one may have to do so (either at the time of the surgery or later) in order to achieve an ideally aesthetic breast. All methods may, and frequently do, use liposuction to achieve optimal cosmesis.

Breast Reduction Techniques?

There are a variety of different breast reduction techniques available. The type of breast reduction technique selected for a patient will depend on several factors including size and position of the breasts as well as skin elasticity and patient goals.

It will be in your best interests to visit with well experienced board-certified plastic surgeons who can most easily demonstrate the different types of breast reductions via photographs and diagrams.

Best wishes.

Breast reduction techniques

Breast reduction surgery removes excess breast tissue and reshapes the contour of the breasts so that they are smaller and perkier. I commonly use a minimal incision technique (Le Jour), eliminating the need for large scars while providing a pleasing breast contour and shape that is proportionate to the patient’s body. This Le Jour technique can now be used on a wide range of sizes and results in a perky, conical breast that many women find desirable. The resulting incision from this procedure looks like a lollipop with the incision around the areola and down to the fold in the breast.

Another technique is the periareolar or “pursestring” which is best for women whose breasts aren’t overly droopy. It results in virtually no visible scarring and a rounded shape. The only downside is that this technique leaves a kind of puckered appearance, but this smoothes out after a few months. Liposuction is typically used to reduce some of the volume when doing a breast reduction, in addition to removing breast tissue.

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.5 out of 5 stars 8 reviews

No best Breast Reduction technique

From your question it seems your are concerned about which of the MANY techniques for breast reduction is the BEST! There is no best. The correct technique is determined by the surgeon for your type of breast. Previous posters have described or outline ONLY a few of the options. For a lay person this will be very confusing. Best to ask these questions to technique in an in person evaluation with a experience boarded plastic surgeon. Other older techniques are the Skoog, McKissock bipedicle, Bisenberg, etc. (just to add to the confusion). 

Breast reduction and techniques

There are many differnt techniques and skin pattern excisions. I certainly want to minimize the incisions for patients. For smaller reductions, and smaller lifts, a vertical skin excision or lollipop incision is good. A wise pattern or anchor type incision is often done for larger breasted patients and for larger reductions with poor skin quality.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Breast reduction or lift scar variations

In general, breast reduction and breast lift are the same except that breast tissue is removed in addition to skin with the reduction. So the terminology used to describe the scar patterns is the same. To begin with, breast lifts/reductions almost always need to move the nipple/areola higher, so there will be a scar around the edge of the areola (it isn't removed and re-attached, just repositioned) .

The simplest type of lift, called a Benelli, periareolar, or donut mastopexy leaves only a scar at the edge of the areola, but it has significant limitations on how much can be done. The next step is to add a vertical tuck from the areola down to the bottom of the breast, leaving a lollipop shape. This is what is usually called the vertical pattern or keyhole. If more skin needs to be removed, it is done along the bottom fold of the breast, so all together it forms an anchor shape. The Wise pattern leaves an anchor shape scar.

No one, including plastic surgeons, wants to leave any more scar than is necessary for good shaping, so the procedure needs to be selected in consultation and it will depend on each individual circumstance.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 30 reviews

Breast reduction techniques differ on the inside and outside of the breast

For patients, the obvious difference between the varying breast reduction technique is the extent and position of the scar. A breast reduction addresses two separate, but inter-linked problems: excess skin and excess breast tissues. The pattern of scars placed on the breast is a consequence of the technique used to remove the excess skin.

For a woman with a breast composed of a large amount of breast skin surface area, it often necessary to use a Wise pattern, or 'anchor' scar to reduce the skin 'acreage' of the breast in both the horizontal and vertical dimension. This scar runs around the nipple-areolar complex (NAC), down the front of the breast and runs along the breast fold for a variable distance.

Some women with more compact, dense breasts, without a huge amount of skin excess do very well with a vertical pattern, resulting in a 'lollipop' scar, which has no scar beneath the breast.

The amount of breast tissue removed, and the pattern with which it is removed is independent of the technique used to deal with the excess skin 'acreage'. The vertical scar technique using a superior or superior-medial pedicle produces an youthful, projecting breast shape that lasts for a long time. The Wise pattern, inferior pedicle technique is reliable and safe for women with very large breasts. Its shape tends to be a little 'boxier' and less projectile.

Liposuction can be used to contour the 'bra roll' portion of the breast, beneath the arm. Liposuction can also be used to reduce the breast volume, but of course, there is no tailoring of the excess skin or lifting of the NAC with this technique.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.