Breast reduction incisions, techniques and scars: Confusing names explained
Wise Pattern = Lexer = Inverted T = Anchor Scar = Verical & Horizontal = Keyhole Scar all describe a technique with a scar around the areola with a vertical scar extending downwards to a horizontal scar in the breast crease (underwire area)
Vertical = Hall-Findlay = Lejour = Circumvertical = Lollipop = Tennis Racket. all describe a technique with a scar around the areola with a vertical scar extending downwards.
The choice depends on the extent of ptosis (sagging) and the surgeon's experience.
Liposuction is commonly used with the Vertical techniques and less freqeuntly withthe Vertical/Horizontal techniques.
Vertical breast reduction better for most women.
In New York City, we use the vertical or lollipop scar breast reduction for most women (unless the breasts are really huge). It shapes the breasts internally and gives much better long term results, as well as less scarring. And we do use liposuction as part of the breast reduction.
Variations to the common breast reduction technique
Thank you for your question. There are many variations to the design of the incisions for breast reduction. The size and shape of your breasts, as well as the desired amount of reduction, are factors that will help determine the best technique for you.
In some instances, it may be possible to avoid the vertical incision that runs from the bottom edge of the areola to the breast crease or the horizontal incision underneath the breast.
Occasionally, the doctor performs liposuction only to reduce the breast size. Candidates for this technique are usually younger and have nipples that are already in a higher, or pointing forward or up position.
Rarely, if your breasts are extremely large, the nipples and areolas may need to be completely detached before they are shifted to a higher level. In such a case, you will need to have made the decision to sacrifice sensation and the possibility of breast-feeding in order to achieve your desired breast size. Best of luck!
Dhaval M. Patel
Double board certified
Differences Between Breast Reduction Techniques
#BreastReduction is performed as an outpatient
procedure and the vast majority of our patients tell us that there was far less
discomfort in the early recovery period than was anticipated. I prefer to use a
minimal incision surgery with a “#vertical” or “#lollipopBreastReduction scar
technique. This method has been used in Europe and South America for more than
30 years but is performed by a small number of Plastic Surgeons in this
country.The trend toward using this
much better procedure is growing as younger plastic surgeons learn this
technique in their residency programs.The benefits include: approximately fifty percent less scarring, a
narrower breast, better forward projection and shape, longer lasting
improvement, shorter surgery time and less complications. In general, we have
stopped using the older traditional “anchor” or inverted “T” incisions as these
provide inferior results. The procedure is done under general anesthesia as an outpatient
#Liposuction may be used during the procedure
to reduce the size of the breast in selected patients. Liposuction alone has
the least number and size of scars but has the greatest limitations in shaping
and reducing the breast. Liposuction may be combined with the vertical method
to give an optimal shape to your breasts. Adjustments of the Nipple and/or
Areola can also be done at the same time.
#scarlessBreastReduction may be performed in older patients who just want some
relief of their excessive breast size and weight.
In rare circumstances, for extraordinarily large or bulky breasts, i.e.
gigantomastia, for technical reasons, we sometimes remove the nipples
completely and reattach them as “free grafts”. The sensory nerves are all cut,
and even though a certain amount of sensation returns after healing, it will
never as it was
prior to surgery. Many of these patients preoperatively do not have this due to
stretch of their nerves. The milk ducts are interrupted in
this operation, so nursing would be impossible. You will be amply informed in
advance if your #breasts are in this category. This may be one of the
exceptions where the inverted “T” or Anchor technique is utilized.
Technique Should Be Chosen For You and Your Goals!
A large number of surgical
techniques are currently available for performing breast reduction
surgery.All of these techniques not
only reduce breast size, but also lift the breast into normal position and
reduce areola size.It’s important to
individualize the surgical treatment plan to address the patients specific
anatomic findings and aesthetic goals.
The inferior pedicle technique with
a wise skin pattern incision is the most commonly performed breast reduction
procedure.This technique utilizes an
inferior pedicle for blood supply to the nipple areola complex.It removes excess skin inferiorly and within
the keyhole pattern.Excess breast
tissue is removed medially, laterally, and superiorly.When the incisions are closed the patient is
left with a classic anchor incision.This includes a circular incision around the areola, transverse incision
at the level of the inframammary fold and vertical incision that connects them.
A large number of surgical
procedures are available for breast reduction that are variants on this
theme.Central, medial, lateral, and
superior pedicle techniques are all occasionally used for blood supply to the
nipple areola.In some cases efforts are
utilized to decrease the length of the surgical incisions.Sometimes lesser incisions such as the periareolar
or lollipop incisions are used.Rarely
liposuction alone can be used when patients have minimal sag.All of these variants have a place depending
upon the patients anatomic findings
If your considering breast reduction
surgery it’s important to consult a board certified plastic surgeon with
experience in this area.This surgeon
should be able to design a procedure that’s tailored to your specific needs.
Breast Reduction Techniques?
There are a variety of different breast reduction techniques available. The type of breast reduction technique selected for a patient will depend on several factors including size and position of the breasts as well as skin elasticity and patient goals.
It will be in your best interests to visit with well experienced board-certified plastic surgeons who can most easily demonstrate the different types of breast reductions via photographs and diagrams.
Breast reduction techniques
Breast reduction surgery removes excess breast tissue and reshapes the contour of the breasts so that they are smaller and perkier. I commonly use a minimal incision technique (Le Jour), eliminating the need for large scars while providing a pleasing breast contour and shape that is proportionate to the patient’s body. This Le Jour technique can now be used on a wide range of sizes and results in a perky, conical breast that many women find desirable. The resulting incision from this procedure looks like a lollipop with the incision around the areola and down to the fold in the breast.
Another technique is the periareolar or “pursestring” which is best for women whose breasts aren’t overly droopy. It results in virtually no visible scarring and a rounded shape. The only downside is that this technique leaves a kind of puckered appearance, but this smoothes out after a few months. Liposuction is typically used to reduce some of the volume when doing a breast reduction, in addition to removing breast tissue.
Breast reduction and techniques
There are many differnt techniques and skin pattern excisions. I certainly want to minimize the incisions for patients. For smaller reductions, and smaller lifts, a vertical skin excision or lollipop incision is good. A wise pattern or anchor type incision is often done for larger breasted patients and for larger reductions with poor skin quality.
Breast reduction or lift scar variations
In general, breast reduction and breast lift are the same except that breast tissue is removed in addition to skin with the reduction. So the terminology used to describe the scar patterns is the same. To begin with, breast lifts/reductions almost always need to move the nipple/areola higher, so there will be a scar around the edge of the areola (it isn't removed and re-attached, just repositioned) .
The simplest type of lift, called a Benelli, periareolar, or donut mastopexy leaves only a scar at the edge of the areola, but it has significant limitations on how much can be done. The next step is to add a vertical tuck from the areola down to the bottom of the breast, leaving a lollipop shape. This is what is usually called the vertical pattern or keyhole. If more skin needs to be removed, it is done along the bottom fold of the breast, so all together it forms an anchor shape. The Wise pattern leaves an anchor shape scar.
No one, including plastic surgeons, wants to leave any more scar than is necessary for good shaping, so the procedure needs to be selected in consultation and it will depend on each individual circumstance.
Breast reduction techniques differ on the inside and outside of the breast
For patients, the obvious difference between the varying breast reduction technique is the extent and position of the scar. A breast reduction addresses two separate, but inter-linked problems: excess skin and excess breast tissues. The pattern of scars placed on the breast is a consequence of the technique used to remove the excess skin.
For a woman with a breast composed of a large amount of breast skin surface area, it often necessary to use a Wise pattern, or 'anchor' scar to reduce the skin 'acreage' of the breast in both the horizontal and vertical dimension. This scar runs around the nipple-areolar complex (NAC), down the front of the breast and runs along the breast fold for a variable distance.
Some women with more compact, dense breasts, without a huge amount of skin excess do very well with a vertical pattern, resulting in a 'lollipop' scar, which has no scar beneath the breast.
The amount of breast tissue removed, and the pattern with which it is removed is independent of the technique used to deal with the excess skin 'acreage'. The vertical scar technique using a superior or superior-medial pedicle produces an youthful, projecting breast shape that lasts for a long time. The Wise pattern, inferior pedicle technique is reliable and safe for women with very large breasts. Its shape tends to be a little 'boxier' and less projectile.
Liposuction can be used to contour the 'bra roll' portion of the breast, beneath the arm. Liposuction can also be used to reduce the breast volume, but of course, there is no tailoring of the excess skin or lifting of the NAC with this technique.