Why Do Some Doctors Choose Anchor Lift over Lollipop?

Hi Newnose33,

     I believe we've answered your previous question regarding Benelli vs. lollipop.

     Your current question actually captures  essential principles on the breast lift procedure and its recent  advances.  There are three incisions that plastic surgeons use on the breast.  These are the one around the areola, the vertical, and the horizontal.  The one around the areola is used to remove skin from the central part of the breast.  The vertical incision is used to remove skin and breast tissue in the horizontal dimension.  The horizontal incision is used to remove skin and breast tissue in the vertical dimension.

     One way to look at the droopy breast is to compare the amount of skin relative to the amount of internal tissue volume.  If a breast has excess skin relative to its volume, then it will droop. It then follows that  to treat the droopy breast one needs to remove the excess skin.   For a long time, the skin was used to lift the breast.  That is, the skin envelope was tightened, and the breast was pushed up as a result.   If there was  excess skin   centrally, then only an areola incision was required, known as the Benelli.  If the excess skin was central and in the horizontal dimension, then an areola along with a vertical incision was required, the lollipop.  Finally, if there was excess skin in all three dimension, then an areola, a vertical, and a horizontal incision was required, a.k.a. the anchor incision.  This was the way the breast lift was done for a long time.  The problem with this surgery is that skin is a poor vehicle by which to lift the breast.  Skin would stretch leading to early relapse, and skin under tension leads to poor scarring.

     Revolutionary techniques emerged to solve this problem. New techniques  developed that do not rely on the skin.  In all these techniques, the internal tissue of the breast is reshaped at a higher position and the skin follows.  These techniques are called vertical mammaplasty, because they only require an incision around the areola along with a vertical (lollipop).  The long horizontal incision (the anchor) is avoided.  The advantage of these techniques is several.  They tend to hold up much longer.  They produce much better scars, and they can often avoid any kind of horizontal incision.  This latter benefit is important.  It is well established that of all the incisions on the breast, it is the horizontal incision that heals the poorest.  Therefore, if one can avoid the horizontal incision then one should.

     To answer your question then, you should try to find a surgeon that is well versed in the vertical mammaplasty technique.  These surgeons would be able to best assess whether you are a candidate to undergo this procedure.

Good luck,

Ary Krau MD FACS

     

     

An anchor is better for lots of excess skin.  A lollipop is better for moderate lifts.  If you have a lot of sagging, I would go with an anchor.

The answer will vary considerable from surgeon to surgeon, depending on their personal preference.  To me, it comes down to one key aspect.  How far does the nipple need to be moved?  A lollipop can be used if the nipple only needs to be moved three inches or less.  More than that, I will usually use the anchor scar.  Hope that makes it simple.

The goal of a breast lift is twofold: to elevate the nipple/areola and to tighten up the skin to give a perkier shape to the breast.  In a patient who already has a good shape but just needs a little bit of a nipple/areola lift then a donut lift would be appropriate.  If a small amount of skin tightening is necessary then the lollipop lift would work.  For someone who is sagging quite a bit and needs a lot of skin tightening then the standard anchor-type breast lift would be the choice.  It is up to the examining (and operating) plastic surgeon to determine which technique would best fit your situation.  I find that the lollipop lift tends to leave a small pucker of skin at the base of the vertical scar.  While many doctors tell me that this pucker resolves over time, I don't think any patient really wants to have a pucker.  With that in mind, I tend to fix the pucker by cutting it out during the surgery.  This leaves a slight horizontal scar but not as much as with the traditional anchor lift. 

   Lollipop lift is a relatively easy technique and requires less time to perform and works well in the right patients.  The full breast lift allows for the surgeon to create a much tighter result with nicer shape and greater longevity.  There are so many subtleties here that you are best to look at results of plastic surgeons.  The round, perky, high, tight breasts with superior pole fullness are achieved by few.  Another key is longevity, and the relative laxity of the skin determines the longevity.  Find the plastic surgeon with ELITE credentials who performs hundreds of breast lifts each year.  Kenneth Hughes, MD Los Angeles, CA