Do I Need a Full Anchor Incision or Could I Possibly Do a Vertical with a Smaller Horizontal Incision? (photo)

I need help in deciding which incision will give me the best result for a breast reduction. I have been to several plastic surgeon consults. I am more confused than ever. I hate the huge horizontal incision but if I really need it to get the best shape and lift I will have to accept that. I am very big (36DD) but not massive, but considerable droop.. grade 3 ptosis. The doc under insurance insists full scar, another says vertical with small horizontal but out of network, alot more $. HELP

Doctor Answers 8

Breast reduction incisions

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Based on the photos alone, I would perform your breast reduction with the full wise (anchor) pattern incisions because I feel that with a breast of that magnitude and degree of ptosis (sagging) I can obtain the best overall shape and size reduction. This of course does not mean that your reduction cannot be done with other techniques. If you know a surgeon that can reliably give you what you want through fewer incisions then you have your answer. Ask both surgeons to show you several examples of their work. You can even ask if there are patients that will talk to you about their scars and their experience. 

Sometimes anchor incision is needed

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In my opinion, your best chance of getting a nice result with good shape (without flattenig of the breast and pleating) and the appropriate amount of tissue removal is to use the inverted T or "anchor" technique.  Often more limited scar techniques work, but for someone with your size and shape, I feel this is the best.  The incisions can be frightening, but they heal beautifully and are well-camouflaged and are rarely an issue.

In fact your reduction may be possible with only a vertical or "lollipop"scar.

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 In fact, your reduction may even be accomplished with just a vertical scar eliminating the need for even a short horizontal scar in the fold. Keep in mind that this conclusion was based on your photos and a hands on exam could result in a different opinion.

David A. Ross, MD (retired)
Chicago Plastic Surgeon

Breast reduction

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In general,  a "t-incision" often permits more tissue to be removed.  If you are borderline for insurance coverage some doctors would opt for this technique for the above reason. I think in general, depending upon what you want for post-op volume, a vertical closure could be an option.

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

Breast Reduction and Concerns about Scars?

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Congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform. Based on your pictures,   I would offer a breast reduction procedure that includes vertical and horizontal excision. Otherwise, I would be concerned that you would be left with too much redundant/loose skin along the lower poles of the breasts.

 I hope this helps.

Breast reduction and length of horizontal/anchor incision

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Depending on the size and amount of sagging of the breasts, a breast reduction can be preformed which results with varying lengths of scars.  For smaller, less pendulous breasts an incision can be performed which result in a scar only around the areola (Donut Breast Reduction), or around the areola and straight down to the fold under the breast (Lollipop Breast Reduction).  If the breast are larger and more pendulous, as in your case, some length of horizontal scar along the fold under the breast needs to be done in order to lift the breast.  The lenght of this incision can vary.  However, remember that the shorter that the length of this incision is made, the less amount of lift and reduction in vertical height of the breast  will be achieved.  Best wishes. 

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.7 out of 5 stars 63 reviews

Vertical incision for breast reduction

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It is hard to determine without an exam, but most often a short vertical reduction will do, and in our experience similar reduction 'weights' are possible with either. The need for revision is also very low for the short scar reduction, and the procedure does not require a drain or an overnight hospital stay. Each surgeon will have preferrences, and the "T" pattern is tried and true. The only other option is to keep looking within your plan to see if someone else favors the short scar approach.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Type of Scar for Breast Reduction

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You may not get a consensus on this question. I suspect the doctor who favors the horizontal incision may need to remove more breast tissue to have the procedure covered by insurance. 

Based on your pictures, a horizontal incision will allow more loose skin to be removed than a vertical incision alone. Adding a short horizontal incision will prevent extra skin from possibly needing to be removed later. 

In most cases with breasts your size and level of ptosis, a horizontal incision will give better results.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

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.