Is Anchor Mastopexy the Best Choice to Correct Sagging Breasts?

32 y/o 34B with sagging breasts encouraged to do 'classic' Anchor mastopexy - advice? I am unhappy with my saggy breasts. I went to a local ABPS certified plastic surgeon, and he suggested I get a mastopexy since I'm happy with the size of my breasts. He suggested making my aureolas smaller and lifting them and using the anchor technique. I have read on several forums the Lejour technique might result in longer lasting results. Any advice on surgery or technique choice? Would implants be better at stopping sag and the dreaded "boob sweat" when braless?

Doctor Answers 13

Anchor vs lollipop mastopexy

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This will continue to be a subject of debate among plastic surgeons because there is no right answer.  Despite arguments on both sides, I rather suspect that how well the lift lasts is more dependent on your own tissues, your elasticity, pregnancy and weight gains and losses.  You can get good and bad results with both techniques depending on who is doing the surgery.

I personally prefer the anchor because in my hands it is extremely versatile and allows me to sculpt the breast to my liking without restrictions.  Go to the doctor whose results look best regardless of the technique.

Mastopexy options

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There is a lot of debate among plastic surgeons about the best procedure for breast lift. The goal is always to get the shape right while minimizing the scar, and the anchor technique has a long track record of success. The LeJour, lollipop, or vertical pattern procedure has also been in use for some time, but it has not been proven to produce longer lasting results.

Is the Anchor technique the best for sagging breasts?

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Although the “#anchor-shape” or inverted “T” incision is still more popular for #BreastLifts in the United States, it represents an older technique with extensive #scarring and a less optimal result in many cases. The rare exception this technique is applied may be for extremely larger breasts. Most commonly, we prefer the #lollipop or #donut lift because of the shape, small scars and easier healing.

Anchor Incision Likely Best Application For Sag

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Your pictures demonstrate significant breast sag in the presence of enlarged areolas. Surgical correction of this problem will require lifting the breast into normal position while reducing the size of the areola’s.Although your pictures are helpful, a physical examination is necessary to determine which breast lift option is best for you.

Because of the severity of your breast sag, a procedure that addresses the excess tissue in both the vertical and transverse dimensions is probably necessary.At minimum, you will need at least a lollipop incision.It’s even more likely that you will need a more extensive anchor incision.

The anchor mastopexy utilizes an incision that extends around the border of the areola.This incision has a vertical extension that connects with an incision located in the inframammary fold.This approach is utilized when patients have severe sag.It addresses sag when there’s excess skin in multiple dimensions.

It’s important to note that breast implants can be utilized with this approach.When patients want increased breast size or more upper breast fullness, this is an excellent option.When volume is adequate, most patients don’t require breast implants.

If you’re considering this type of procedure, consultation with a board certified plastic surgeon is appropriate.This surgeon should be able to formulate an appropriate surgical plan for correction of your problem.

Best result with a vertical breast lift

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You would be a good candidate for a vertical mastopexy.   There are several different types of breast lifts including a peri-areolar crescent lift, a doughnut or Benelli lift, a Vertical Mastopexy and a Key hole or anchor type mastopexy.  All have specific parameters.  Based on your appearance and the degree of breast tissue below the inframammary crease you would get the best result with a vertical mastopexy.

Anchor Vs Short Scar (Lollipop) Breast Lift

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The best breast lift technique in part is what your plastic surgeon is most comfortable with. In my practice I would recommend a lollipop technique over a traditional Anchor pattern technique. I have been in practice for more than 25 years and it has been divided up into my first half of my career for moderate to significant sagging breasts performing anchor pattern lifting for first decade of practice and lollipop technique for the last half of my practice. For me their is no comparison - the lollipop technique is far superior. I do NOT have any problem however that other plastic surgeons are more comfortable with the anchor pattern technique if this is what they do best.

The procedure is done on an outpatient basis under intravenous sedation and local or general anesthesia. As mentioned above there are a variety of techniques for these operations.  Most commonly there is an incision around the areola, with a vertical incision on the lower part of the breast ( vertical or “lollipop” technique).  Although the “anchor-shape” or inverted “T” incision is still more popular in the United States, it represents an older technique with extensive scarring and a less optimal result in many cases.  These new techniques are utilized in the vast majority of cases, the rare exception being extremely large breasts.  The nipple-areola complex is repositioned higher, the excess skin is removed, and the breast is reshaped in a pleasing contour and in a more normal position.  The insertion of an implant as well, may be advisable to restore superior fullness which is lost with aging and after pregnancy despite the rest of the breast being overly large.

Breast Lifting Technique?

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Thank you for the question and picture.

I think you should have an excellent result with breast lifting surgery;  you should do well with either technique that you mentioned. The results of your surgery will depend more on your surgeon that on the specific procedure performed. In other words, I can imagine you ending up with beautiful results if you pick your plastic surgeon carefully.

Best wishes.

Breast lift

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From your photos, you m ay be a good candidate for a vertical lift, but you have to realize that your nipple areola complexes will more than likely still be lateralized.

Breast lift method

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There is no “right” method for mastopexy. Sometimes it is just what works best in a particular surgeon’s hands. I personally rarely use the “anchor” incision, but find it necessary occasionally. I do not, however, use the LaJour method, as I have found it unnecessary to get longevity and I get better form with a modification. This does not mean this is best, just that it works best for me. I would also never use an implant to achieve lift if your present size in an unpadded bra is OK.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Breast Lift VS. Breast Augmentation WITH Lift - "Short Scar" VS. Anchor Mastopexy

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In the debate of WHAT OPERATION to have - Breast Lift or Breast Augmentation with Lift - the simplest way to decide is for you to answer the question - Are you happy with the SIZE of your breasts? IF the answer is  - YES - then all you need is a Breast Lift (Mastopexy). If you would like more volume, you need breast implants and would need a Breast Augmentation WITH a Lift.

Breast Implants do NOT stop sagging - they accelerate sagging. The breasts are organs which WILL sag with time. Unless breast implants are filled with Helium, they add weight to the breast and will hasten the sagging process.

If you ONLY proceed with a Breast Lift (Mastopexy), there are 2 competing schools of thought in Plastic Surgery regarding the procedure.
- Breast contouring by only changing the shape of the breast skin envelope (= methods such as Anchor / inverted T / Wise pattern etc)   OR
- Breast tissue modification Breast Reduction / Breast Lift Techniques (Lejour, Hall-Findlay techniques etc). I prefer the Hall-Findlay technique because it last much longer than the skin modification Breast Lifts AND has limited scarring (a lollipop scar).

If you are unsure which way to go, you may wish to see other Plastic surgeons to help you understand the benefits and drawbacks of each of your options.

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

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.