What is the difference between a lollipop and anchor incision with breast reduction?

Thank you for your question.  This is an excellent
one, as many people want to know the answer to this.  The incision pattern used for breast
reduction surgery depends on several factors: the elasticity of a patient’s
skin, how much breast tissue removed, and the desired results.  
 
A vertical incision pattern (often called the “lollipop” incision)
is a technique that involves making an incision around the areola and then a
vertical incision from the areola, down the center of the breast, to the
inframammary fold (where the bottom of the breast connects to the
chestwall).  One of the greatest
advantages of this method of breast reduction is that it often produces the
best looking breasts. Short-term, the breasts may even look as full and as high
as breast implants. Longer-term, as they soften and settle, they maintain great
shape —to my eye, better than the other methods of breast reduction.
 
The “anchor”
incision, which involves making a horizontal incision along the
inframammary fold. The anchor-shaped incision pattern allows me to manage the
great excess of skin that some women need to have removed with their breast
reduction.
 
In my practice I find it possible to use the Lollipop
incision is about 95% of patients.  The
other 5% of patients with extremely large breasts may need an anchor incision. 
This is all discussed and agreed upon prior to surgery!
 
Make sure you choose an experienced,
board-certified plastic surgeon.
Take time to specifically look at before and after pictures of real
patients who have had this surgery performed by your surgeon and evaluate their
results.  During your
consultation your surgeon can make a recommendation on which incision will be
best for you.
Best
of Luck 
Dr.
Romanelli

This decision is not really a patient decision.  It is a decision made by the surgeon based on what he or she feels will give you the best results. As a general rule, a lollipop incision is used for small or medium sized reductions, and an anchor incision is typical for a larger reductions.  More skin can be removed with the anchor incision. Your breast measurements also play a role in the type of incision that is best for you. If the length of the lollipop incision is too long, surgeons generally make a transverse or side to side incision to better shape the breast.  Also keep in mind that the bottom incision will also vary in length.  Discuss these details with your surgeon who can give you specific recommendations based on his or her examination. Best wishes to you.

With an anchor incision (where the scar has the lollipop and goes across the bottom of the fold of the breast, you can remove more skin, and thus lift the breast more.  Lollipop incisions alone limit the scar but also limit the amount of skin that can be removed.  So it depends on your physical exam, and also your surgeon's familiarity with one technique vs another.  I would not get set on a particular procedure; I would rather find a surgeon you like and trust, and see what they recommend.    Breast reductions are one of my favorite surgeries to do, as it is a life changer for patients and the results are amazing!

Dear Janastasia,Thanks for the question.Most larger breast reductions require an anchor incision to lift and reduce the breasts.  The scars go around the areola (dark area outside your nipple), downward to the bottom cresa of your breast and then out towards the cleavage and out towards the lateral breast (armpit side).  A lollipop incision can be used in smaller reductions and lifts.  This scar only goes around the areola and down towards the crease looking like a "lollipop" if you just look at the scar.A physical exam would answer which procedure and scar would work best for you.Dr T

In a true breast reduction, the inverted T incision is used. This assumes a real need for resection of breast tissue and not a lift called a reduction.  In a lift, if the amount of ptosis is low and the breasts are small, a lollipop incision, with sutures only around the areola, is sometimes used but will not produce the same lasting result as the traditional operation.  The appropriate procedure is patient specific and can only be determined in consultation. Best wishes.

Many thanks for your question. A lollipop or vertical scar breast reduction is suitable for smaller and some moderately sized breast reductions. A full (anchor pattern) breast reduction allows much larger breast reductions to be performed as it allows significantly more tissue to be removed in both the horizontal and vertical directions.As to which is most suitable for you, that would depend on assessment in clinic by an experienced plastic surgeons and depends on a number of measurements of the dimensions of the breast, the size of the reduction and the experience of the plastic surgeon with the different techniques. Generally speaking if you require a moderate to large reduction a full breast reduction will give you a better result.Good luck with your treatment.

Thank you for your question.  This is an excellent one, as many people want to know the answer to this.  There are two main things to understand.  Inferior pedicle reductions are almost always associated with an anchor pattern scar.  I do not prefer inferior pedicle reductions because they tend to bottom out after a year or so, but many surgeons utilize them in their practices with very good results.  Inferior pedicles are great for patients who need very large reductions.  In most cases I use a superior pedicle, where the blood supply to the nipple is maintained by tissue at the top of the breast.  This type of pedicle does not bottom out as much, thereby maintaining fullness in the upper half of the breast and gives a good shape.  With a superior pedicle, I can almost always do a limited lollipop incision.  In some cases I need to add a short incision in the crease, but not the long one that is used in a full anchor pattern.  The reason I sometimes have to add a short incision in the crease depends on the length of skin between the bottom of the areola and the crease.  If this distance, or length of skin, is too long, it does not look as pretty as it should.  So the shorten this distance, skin is removed and this requires a short incision in the crease.  The lower the nipple is to start, the greater the distance it needs to be elevated and, therefore, the longer this distance from the areola to the crease will be.  So if the nipple is very low, chances are you will need a short incision in the crease.  I hope this helps. 

I base my choice on the size of the breasts and the degree of sagging and ptosis. When a larger amount of skin and lift is needed I use an anchor approach. The difference between the two being the incision under the breast with an anchor approach. I would recommend you see a board certified plastic surgeon in your area for a consultation who will make a recommendation.

Thank you for the question.
 It is not possible to give you precise advice without direct examination or viewing photographs. Some general thoughts may be helpful to:

 Different patients will present with different degrees of "sagging" (breast ptosis).  The type of breast lift indicated will mainly depend on the patient's physical examination and goals.  Breast lifting involves some degree of tightening and lifting of the breast skin envelope.    Very minor "sagging" may be corrected using a circumferential areolar incision (Benelli breast lift) ; more severe breast ptosis may require a vertical or "anchor" breast lift pattern.

Generally speaking, the difference between a vertical "anchor breast lift comes down to the pattern of skin/tissue removed. The resulting breast shape and resulting scars will differ between the two operations.  The vertical  breast reduction (or lift) will lead the patient with a "lollipop" pattern scar; the anchor breast reduction, on the other hand, will leave the patient with an "inverted T" pattern scar.

 You will find that there is no "algorithm" when it comes to determining what type of breast lift up patient should undergo.  In other words, you will likely receive differing opinions from different plastic surgeons.  

 Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices.  Although these different opinions can be confusing and a source of anxiety for patients, it is good for patients to understand the different options available.

My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as  well.   I find that the use of goal photographs and computer imaging are very helpful during this communication phase. Working together you will come up with a good plan to achieve your goals.   
 I hope this helps.