Why Do Some Doctors Choose Anchor Lift over Lollipop?

Question

Just had a consult for a straight lift--no implant or reduction-- and dr said I am stage 3 ptosis (36 DD), lots of volume still, and wanted to do an anchor lift. Of course I'd prefer a lollipop due to scarring. After reading this site it seems like it's a gray area on when to use one over the other. My doc said lollipop gives a better conical shape but I would still get an anchor. Why do you choose one over the other when no implant or reduction is needed?

Ary Krau, MD, FACS · Answer

Hi Newnose33,

	     I believe we've answered your previous question regarding Benelli vs. lollipop.

	     Your current question actually captures  essential principles on the breast lift procedure and its recent  advances.  There are three incisions that plastic surgeons use on the breast.  These are the one around the areola, the vertical, and the horizontal.  The one around the areola is used to remove skin from the central part of the breast.  The vertical incision is used to remove skin and breast tissue in the horizontal dimension.  The horizontal incision is used to remove skin and breast tissue in the vertical dimension.

	     One way to look at the droopy breast is to compare the amount of skin relative to the amount of internal tissue volume.  If a breast has excess skin relative to its volume, then it will droop. It then follows that  to treat the droopy breast one needs to remove the excess skin.   For a long time, the skin was used to lift the breast.  That is, the skin envelope was tightened, and the breast was pushed up as a result.   If there was  excess skin   centrally, then only an areola incision was required, known as the Benelli.  If the excess skin was central and in the horizontal dimension, then an areola along with a vertical incision was required, the lollipop.  Finally, if there was excess skin in all three dimension, then an areola, a vertical, and a horizontal incision was required, a.k.a. the anchor incision.  This was the way the breast lift was done for a long time.  The problem with this surgery is that skin is a poor vehicle by which to lift the breast.  Skin would stretch leading to early relapse, and skin under tension leads to poor scarring.

	     Revolutionary techniques emerged to solve this problem. New techniques  developed that do not rely on the skin.  In all these techniques, the internal tissue of the breast is reshaped at a higher position and the skin follows.  These techniques are called vertical mammaplasty, because they only require an incision around the areola along with a vertical (lollipop).  The long horizontal incision (the anchor) is avoided.  The advantage of these techniques is several.  They tend to hold up much longer.  They produce much better scars, and they can often avoid any kind of horizontal incision.  This latter benefit is important.  It is well established that of all the incisions on the breast, it is the horizontal incision that heals the poorest.  Therefore, if one can avoid the horizontal incision then one should.

	     To answer your question then, you should try to find a surgeon that is well versed in the vertical mammaplasty technique.  These surgeons would be able to best assess whether you are a candidate to undergo this procedure.

	Good luck,

	Ary Krau MD FACS

Sheila S. Nazarian, MD · Answer

An anchor is better for lots of excess skin.  A lollipop is better for moderate lifts.  If you have a lot of sagging, I would go with an anchor.

Ronald J. Edelson, MD · Answer

The answer will vary considerable from surgeon to surgeon, depending on their personal preference. To me, it comes down to one key aspect. How far does the nipple need to be moved? A lollipop can be used if the nipple only needs to be moved three inches or less. More than that, I will usually use the anchor scar. Hope that makes it simple.

Edwin C. Pound, III, MD · Answer

The goal of a breast lift is twofold: to elevate the nipple/areola and to tighten up the skin to give a perkier shape to the breast. In a patient who already has a good shape but just needs a little bit of a nipple/areola lift then a donut lift would be appropriate. If a small amount of skin tightening is necessary then the lollipop lift would work. For someone who is sagging quite a bit and needs a lot of skin tightening then the standard anchor-type breast lift would be the choice. It is up to the examining (and operating) plastic surgeon to determine which technique would best fit your situation. I find that the lollipop lift tends to leave a small pucker of skin at the base of the vertical scar. While many doctors tell me that this pucker resolves over time, I don't think any patient really wants to have a pucker. With that in mind, I tend to fix the pucker by cutting it out during the surgery. This leaves a slight horizontal scar but not as much as with the traditional anchor lift.

Kenneth Hughes, MD · Answer

Lollipop lift is a relatively easy technique and requires less time to perform and works well in the right patients. The full breast lift allows for the surgeon to create a much tighter result with nicer shape and greater longevity. There are so many subtleties here that you are best to look at results of plastic surgeons. The round, perky, high, tight breasts with superior pole fullness are achieved by few. Another key is longevity, and the relative laxity of the skin determines the longevity. Find the plastic surgeon with ELITE credentials who performs hundreds of breast lifts each year. Kenneth Hughes, MD Los Angeles, CA

Brian C. Reuben, MD · Answer

Thank you or your question.  This is a very common question and there are often many factors that go into why a surgeon chooses a particular method.  No surgeon likes to have extensive scars, to many will use a lollipop incision when able.  However, patient factors such as skin quality, the size of the breast you are starting with and your ultimate goal size and the shape of your breasts can push a surgeon one way or another.  Generally, the more skin you have to get rid of, the greater the likelihood of needing the anchor scar.  

	Other factors can also influence a surgeons choice of the scar used, such as their past experience, their preference, where they trained, etc.  Ultimately, you should choose a surgeon you feel comfortable with, someone you think understands your goals.  They can then discuss their approach, show you photos of similar patients and the two of you can come up with a plan to get you the look you want.  

	Best of luck.

Gilbert Lee, MD · Answer

Dear Newnose,

	the majority of mastopexies can be accomplished via a lollipop lift.  the advantage of this procedure is a more limited scar, and less bottoming out over time.  I try, whenever possible to limit the scar to the lollipop.  However, there are some patients with grade 3 ptosis (the most advanced grade of breast droop) that have so much redundant skin that an anchor scar just be added to remove the skin in a different dimension.  This transverse scar may be small or larger depending upon the amount of skin to be removed.

Larry Fan, MD · Answer

Dear Newnose33,

	A breast lift with or without implants is an excellent way to lift and reshape your breasts.

	There are a variety of options for lifting the breasts, including using implants alone; performing a breast lift (periareolar vs. vertical vs. anchor lift) alone; performing a breast lift with implants.

	Choosing the right option for you depends on your breast size, breast shape, skin quality, and desired outcome.

	In general, neither patients nor surgeons desire scars, but the fewer the scars, the more limited the ability to life and reshape the breasts. Choosing a shorter scar option may increase the risk of a suboptimal result, albeit with the benefit of shorter scars.

	Choosing between the vertical (lollipop) and anchor lift depends on the amount of sagging you have. An experienced surgeon should be able to guide you through this choice with an in-depth interview and examination.

	As an additional note, for most patients, the vertical scar (used in both the vertical/lollipop lift and the anchor lift) is the most visible scar. The anchor lift adds a horizontal scar along the lower breast fold. This scar is often quite hidden and thus less of a concern, so most surgeons would recommend that you choose the option that is going to best achieve the desired result.

	 

	I hope this helps.

	Warmest wishes,

	Larry Fan, MD

Tom J. Pousti, MD · Answer

Thank you for the question.  Although it is not possible to give you a precise answer,  without photographs or direct examination, some general thoughts may be helpful to.

	 Generally speaking, it is the nature of plastic surgery to potentially receive different opinions from different plastic surgeons about how best to “treat” a specific problem.In other words, if you ask enough plastic surgeons the same question,  you will eventually hear the answer you're hoping to hear.  

	Often plastic surgeons opinions are based on their own personal experience/preferences, sometimes based on previous patient outcome.
	 

	If I were in your shoes, I would concentrate on due diligence in the selection of plastic surgeon.  This careful selection, as opposed to selecting a plastic surgeon who will do the operation you are hoping for,  will be the most important decision you make when it comes to the successful achievement of your goals.

	Many patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do in the field of plastic surgery.

	 I hope this helps.

Jourdan Gottlieb, MD · Answer

I think it is fair to say that most surgeons use the lollipop lift most of the time. That technique allows for repositioning the nipple and areola, and removing excess breast skin in the horizontal direction with the vertical incision.

	Some patients have also too much excess in the vertical direction, and occasionally a horizontal incision will be added to the lollipop to make the anchor incision. 

	Without a photo it is not possible to offer specific advice, other than getting more than just one opinion. All the best.

Why Do Some Doctors Choose Anchor Lift over Lollipop?

Answers (13)

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