Breast Lift with Vertical Scar or L-shaped Scar?

I had a consultation with two doctors today and I was given different options for my breast lift. One doctor would do something like the traditional anchor scar, but rather than the inverted "T" incision, he would do something like an "L" along the lateral side. The other doctor suggests a more "modern" style with just a vertical scar, that developed by Dr. Elizabeth Hall-Findlay. I am a bit nervous about this second option because the doctor explained that that is puckering at scar for the first 3-6 months, but that it eventually stretches and looks fine. Thoughts on this?

Doctor Answers 16

Why not both!

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I would recommend the vertical reduction, only limiting the vertical puckering by extending the incision horizontally along the inframammary fold.  This would limit the inframammary fold incision length of the L procedure and still give you a nice shape.  Best wishes

Breast augmentation and mastopexy

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Based on experience, I would suggest that your 1st concern should be obtaining the best results possible (scarring concerns should be secondary).  Most patients undergoing this procedure will accept scarring as long as their overall goals in regards to size, shape, contour and symmetry are met.

In other words, if you select your surgeon based on  the offer of a “limited scar” procedure you may be disappointed with the results.

Also, be careful about communicating your goals with specific cup size references.  You may find this to be inaccurate and again a source of dissatisfaction postoperatively. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.

I hope this helps.

Focus less on technique and more on quality...

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Hi there-

My colleagues have all done a very good job explaining the options to you...

I would add, however, that your best interests will be best served by spending less energy and time thinking about the details of the operation your surgeon will perform, and more time and energy on the surgeon himself...

Do you like the surgeon you think you will choose? Where did he go to school? Where did he do his training? Is he certified by The American Board of Plastic Surgery? Where will the procedure be performed? Who will do the anesthesia? What do the surgeon's prior patients have to say about him? What do his outcomes look like?

These questions will all be more important to your happiness and safety than the details of the operation.

In other words, if you choose a surgeon well, you would be able to be confident that his recommendation will be safe and have a high likelihood of achieving your goals.

Here is some more advice on how to do so:

Different breasts may require different approaches

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Unfortunately, your breasts are very different and each presents its own problems. You could have different types of mastopexy's on each side to try and equalize the shapes and different sized implants for size equalization. You breasts require that you see a plastic surgeon with a large experience!

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 28 reviews

Breast Lift scars depend on how much lift

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There are different techniques in mastopexy (breast lift) and they vary with the amount of lift required and by surgeon. No breast lift technique can be applied to all breasts and considering you have considerable asymmetry it may be difficult to predict how long/many scars you may have. It looks like you may have a form of lower pole constriction causing a high fold and early ptosis. Both techniques described will likely work just as long as they treat the underlying problem. I would disagree that the vertical superior medial pedicle is more modern and find that the bunching it causes does not settle out and leaves me doing revisions after 6 months. I am glad that you sought multiple consults, just make sure that they are board certified in plastic surgery. Remember the goal is to lift the nipple and shape the breast in the mastopexy so both scar patterns (vertical, J, T etc) will work.

I hope this helps.

Dr. Trussler

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 52 reviews

Mastopexy scars can vary

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Different surgeons can achieve beautiful results with different scars, so I recommend not getting hung up on the scars. Not all vertical mastopexy techniques create puckering post op. Also, if the length of the vertical segment is going to be too long, then it makes sense to extend it into an "L" or inverted "T" scar.

In your case, there is a significant difference between your breasts. Each will require a different treatment, and this may result in different scars. If you were my patient I would be recommending a left mastopexy and a right reduction in order to achieve symmetry in size and shape. The right breast will be significantly larger than the left if it is only lifted.

Bruce E. Genter, MD, FACS
Abington Plastic Surgeon
4.3 out of 5 stars 17 reviews

Lift options

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You have a complex presentation. either may or may not be fine depending on the surgeon. You have a wide inter-mammary distance. Personally, I would at least consider a traditional mastopexy, and likely breast implants to fill in the cleavage area. Possibly two procedures

Hall-Findlay IS the Answer

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The two options offered you differ not only in their scars but most importantly in HOW the breast is shaped and lifted and in the DURABILITY of the lift.

The anchor / inverted T / keyhole / Weiss pattern breast procedures lift breasts by reducing the skin envelope. As a result, like everything else which depends on long-term skin integrity, the results do not last long. Skin stretches and sags and so will these breasts. Every single one of them.

The Hall-Findlay procedure depends primarily on shaping the breast tissue itself. Once the breast is coned and made perky only then is excess skin removed. since a lot less skin is removed, the operation does not require long scars and stopped using the transverse scar. The gathering at the bottom of the vertical limb ALWAYS flattens. Among the many such cases we did in our practice, we did not have to go back even one time to flatten the gathering. (You may want to look at scar revision rates with the Vertical T pattern procedures. Much higher).

Your asymmetry will be much narrowed and the breasts will be perkier for a long time with minimal scarring. What's not to like?

Peter A. Aldea, MD
Memphis Plastic Surgeon

Vertical scar best for breat lift.

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When doing breast lifts in New York City, we always use the vertical lollipop scar. And the short scar is not even the main advantage of this approach. It is great because the breasts are shaped and lifted INTERNALLY, without relying on skin tension, and so you get good long term shape.

Most breast lifts are done by tightening the skin envelope. But skin stretches, and the lift doesn't last.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Breast lift procedures

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I use a technqiue of vertical lifting a little different than Betsy's. An "L" is perfrectly oK as well as the shape comes out nicely. All lifts require some time for thebreasts and scars to settle

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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