Breast Lift Technique with Scar Under Crease and Around Areola?

I am interested inhaving a breast lift with breast augmentation. I am a 36DD with severe drooping now. I want to be a 36DDD after surgery. Doctors have recommended the anchor lift with augmentation. I consulted with one doctor who said the same, but also said I'm a candidate for a technique which I will only have a horizontal scar under my breast and around the areola. He said my breast will be nicely shaped and the lift will be good, with NO VERTICAL SCAR. What's this technique called and do any doctors from RealSelf perform this with augmentation?

Doctor Answers 17

Why the Verticle scar is necessary sometimes in a breast lift.

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Dear SashaDC,

Thank you for your question.

In order to best understand what a breast lift does, I often use the anology that in advanced cases of ptosis (or breast "droop/sag") that the procedures primary effect is to re-cone the breast.

A youthful breast is more cone like, or "perky". 

As one ages, breast feeds, weight fluctuations, etc, the breast loses that shape and begins to flatten, and in some cases hang low.

The key to reconing a breast is the vertical incision. In some advanced cases, the lower, or infra-mammary incision is also needed.  This is either a Verticle lift, or inverted T lift.

The nipple lift is more related to positioning the Nipple/Areolar complex (NAC), but will not be adequate to significantly lift the breast tissue.

I hope this helps,

Sergio Pasquale Maggi, MD, FACS
Austin Plastic Surgery Center

Breast lift possible

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I would need to examine you to give you a definite recommendation.  As you may know, there are four types of mastopexy: 1) Periareolar, 2) Circumareolar (donut), 3) Circumvertical (lollipop), 4) Wise-pattern, full lift (Anchor).  Depending on the degree of ptosis (sagging), you will need different types of mastopexy.  In general, as one needs more lift, the scar pattern becomes more complex.  Please visit with a board-certified plastic surgeon so that she/he can evaluate you and review the options for you.

36DD lift or reduction?

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Thanks for your question. You would be a great candidate for either a reduction or a lift. Without a vertical incision its hard to adequately shape the breast. If you like your general size then a lift would be the procedure of choice and you would loose very little volume. The best way to evaluate ptosis (sag) is by physical exam but a picture can give a preliminary idea. The best picture is a side profile. In general breast lifts are done to not only raise the nipple but also to make the areolar/nipple complex smaller and raise the breast tissue to a more natural youthful position. Of course, the key to a great breast lift is patient selection and technique selection. Areolar lifts are generally good for women with good skin quality, breast tissue reasonably placed and a nipple/areola that are sagging no more than 2 cm. Once the breasts sag past that point, it is necessary to perform a lollipop lift which not only repositions the sagging breast tissues but also the nipple and areola. The final and most aggressive lift is an anchor lift which places both a vertical and horizontal incision. Again the determinant is the degree of sagging, skin quality and amount of breast tissue. Last, if there is a deficiency in breast tissue, an augmentation can be done either together with the lift or as separate procedures. Make sure you visit with a board certified plastic surgeon get get specifics on your situation.

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Many types of breast lift proceudres and options

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You would be a good candidate for a vertical mastopexy with a breast implant for volume.  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 with a breast augmentation.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Breast lifting without a vertical scar

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It is possible to do a lift without a vertical incision, provided that a circumareolar scar and a horizontal scar in the fold of the breast would be made.  This does not always guarantee a good result, however.  Please remember that a breast  enlargement performed without a suitable lift for your shape would only give you a more enlarged , drooping breast.  Without photos it is impossible to give you a very appropriate answer about this .  Always let your Plastic Surgeon give you an opinion about this, anf if you have concerns about the suitability of the advice, get another opinion from another Plastic Surgeon .  I  have performed several of these operations in the past with good results, but that does not guarantee that you would have similar results, because it would be impossible to predict this without seeing photos of you.


Good luck to you.  Frank Rieger M.D.  Tampa Plastic Surgeon

Breast Lift without Vertical Scar?

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Thank you for the question.

Unfortunately, it is not possible to give you precise advice without direct examination.

The no vertical incision breast lift can be useful but only in a few percentage of patients who are seeking breast lifting surgery. The majority of patients seeking breast lifting surgery benefit from excision of skin (and sometimes tissue) in the vertical and horizontal dimensions.  This vertical component allows for better shaping of the breast mound.

Fortunately, the majority of breast lifting patients are pleased with the results of surgery (despite scars).

Best wishes.

Breast lift with augmentation options

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It’s hard to say without a photo which placement fits you the best. There are various factors regarding how you want your breasts to look and feel, but if you and your doctor have a good, open line of communication, you shouldn’t need to go back and forth on your decision. If you just want to go bigger, the only way to do that is with implants. Any type of incision for a breast lift will leave a scar, but there are ways now that are minimal scarring and give a pleasing, perky result. The vertical or Le Jour technique can now be used on a wide range of sizes using an incision that looks like a lollipop that goes around the areola and down the lower half of the breast.

A major factor that effects how breast implants look and feel is whether they're inserted over or under the chest (pectoral) muscle. I do submammary and submuscular implants, inserting the implants under the breast tissue and over the muscle through an incision in the breast fold. The result is fabulous: perkiness with barely a trace of scar.  

If you want the most natural-looking breast you'll need a subpectoral implant, in which the implant is placed under the muscle. This procedure also requires the merest incision - about three centimeters in the crease under the breast or at the edge of the nipple -- and diminishes the incidence of capsular contracture, the formation of hard scar tissue around the implant which occurs in 10 to 30 percent of cases.  

Subpectoral implants aren't right for everyone, though. If you have saggy breasts, an implant placed under the muscle won't fill out that empty breast sack, and you'll get what we call the "double bubble" look, where the implant is situated next to your armpit and the breast hangs several inches below it. Instead, you can have a procedure called augmentation mastopexy, in which the implant is placed under the muscle and the skin on the breast is lifted and tightened.  

In short, you must know -- realistically -- what you are starting with, as well as what you want to look like when surgery is done. Do you want a natural appearance or a round, perky look? These are some of the factors I weigh with my patients when evaluating what type of procedure to do.  


Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.6 out of 5 stars 10 reviews

Can I have a Breast Lift with only scars around my nipples and under the fold?

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Hi there-

This technique was popularized by Dr. Lalonde in Canada, and is a viable technique, however, the shape of the breast is never very nice... so in my opinion, it's not a very good option.

My thinking as a plastic surgeon is that if we are going to do an operation to improve the appearance of your breasts, the only operation that makes sense (considering that you are going to undergo surgery, spend money, and go through a recovery process) is one that is HIGHLY LIKELY to give you the most beautiful breasts possible. Think about this very carefully... The only thing worse than being unhappy with your appearance is having surgery, spending a lot of money, and STILL being unhappy with your appearance. Repeat that to yourself a few times. Make SURE whatever operation you sign on for is one likely to give you the breast shape you want.

The scars are an important consideration, but if you select a good surgeon, they will all heal well more often than not- in fact, I can tell you that I have net ever had a patient tell me they regretted the operation because of the vertical scar- as it is usually the portion that heals the very best.

Here's a bit more about choosing a plastic surgeon:

Anchor scar breast lift

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There is a procedure for women whose nipples are completely below the crease under the breast in which the vertical scar is eliminated. The problem is that it doesn't give as good shape as when the vertical scar is used.

The vertical scar is what gives the projection and conical shape to the breast. The vast majority of patients will trade the scars for the best shape and there will never be a procedure for significantly droopy breasts that doesn't involve scars.

Breast Lift Without Vertical Scar

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I find it interesting that women who are about to undergo a breast lift are always concerned about the vertical scar. Yet, women who undergo breast reduction don't really care. The vertical scar is necessary to create a more rounded shape. Although a lift can be done without it the breast tends to be more flat appearing.

So my advise is to get the right surgery that will give you the best, most well shaped breasts. The vertical scar will fade and is really only a concern to you.

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.