Breast reduction: lollipop vs anchor?

Thank you for your question, The Horndeski Method/The Bellesoma Method is a current technique to lift and/or reduce breasts without using implants or the ugly vertical scars.  The incisions are hidden around the areola and in the inframammary crease. The vertical incision has been completely eliminated. The areola incision heals almost invisibly due to the fact that there is hardly any tension on the closure. With this particular technique, ducts are preserved along with nerve supply maintaining nipple sensation and the ability to breast feed. Because the breast is reshaped internally and is secured to your chest muscles, upper pole fullness is possible without an implant. Usually patients do not go down in size very much with this technique.  Attached is a patient who underwent The Horndeski Method/The Bellesoma Method. Please note that her tissue was used to create upper pole fullness and cleavage without any foreign materials (mesh, implants, etc).  It is a proprietary technique that only surgeons that have been trained by me can perform. I hope this helps. Best wishes and kind regards, Dr. Gary Horndeski

Lollipop incisions are all that is needed in the vast majority (perhaps 95-97%) of my patients. About 3-5% require anchor incisions because of having a great excess of skin. Going from a G-cup to a C-cup is a sizable difference, and may be a factor, or maybe not.  Not all surgeons are experienced or comfortable with the lollipop incision, which I find produces a better breast shape than anchor incisions, especially in the long run. Seek the opinion of surgeons who use both techniques. Best of luck!

There is no definitive rule for whether to use a lollipop or anchor shape incision pattern.  I use both regularly and make the decision on a case by case by basis.  The choice is based on many factors but much of it has to do with the size and shape of the breast and the proportion of skin relative to breast tissue that is being removed.  For larger breast reductions greater than 500 grams per side, I usually consider an anchor pattern to avoid having to remove extra skin as a revision procedure.  In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
Best of luck,
Keith M. Blechman, MD
New York, NY

I perform a lollipop incision for most of my breast reductions. The breast tissue can be adequately removed and reshaped using a vertical breast reduction technique with a short lollipop scar for many patients. However, some patients with excess skin  or size will benefit from the anchor incision. You may consider asking your surgeons to show examples of pre and postoperative photos using the various techniques. This should help you make a decision.

In my experience of performing both of these operations routinely, they are both terrific techniques with good results, but the choice should be tailed to the SHAPE of your breast.  This is not something that you can determine without an in-person exam.  You should find women that is comfortable in both techniques and can give you the reasons why they think you are a better candidate for one or the other.  Breast reduction eligibility and coverage by insurance varies from one insurance carrier to the next, and cannot be determined based on cup size, but only based on an in-person examination to figure out how much tissue the surgeon needs to remove.  You also often have to qualify for multiple other criteria from your insurance carrier, so be sure to request their breast reduction coverage policy ahead of time before your plastic surgery visit to ensure you meet all the other non-size related demands that they have.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.  

Hi, thank you for your question.  Every surgeon has his or her own preferred technique for each surgery.  I use the vertical ("lollipop") incision on 95% of my breast reduction cases.  I have found that surgeons who routinely state it's not possible to use this incision are simply not comfortable with the technique.  In cases in which there is significant excess skin, as may occur following weight loss, the anchor incision is sometimes necessary to remove this excess.  I suggest looking at your surgeons' before and after photos to determine what results match your goals and moving forward from there.Best wishes,Dr. Naidu

In my practice, I perform many different types of breast reductions. I choose the technique based on the patients desires, anatomy and other issues including skin elasticity and any previous surgeries.
For patients with a sternal notch to nipple distance of less than 25cm's, I will offer the Goes Technique (a circumareolar procedure that reduces and lifts the breasts with an internal brassiere) or the Lejour technique (a lollipop technique that gives the best shape). The Goes technique is durable but not as perky as the Lejour.For patients with a sternal notch to nipple distance of 25-35 cm's, I will offer one of two Lollipop scar techniques. The Lejour Technique (in my opinion) gives the best shape and durability of all techniques discussed. I can make a significant volume reduction and almost never need to add a transverse incision. The Hall-Findlay Technique is my second choice and I only use it for patients that have previous scars on the upper half of the breast. These scars can limit the blood supply for a Lejour technique, so I choose the Hall-Findlay for these patients. The problem with the Hall-Findlay is that the shape is not as nice or perky as the Lejour, and for the bigger/lower breasts, the scar must be changed to an anchor scar.For patients with a sternal notch to nipple distance of more than 35 cm's, the only technique I use is the Mckissock technique - an anchor scar technique. While this technique has been around for a long time, it has stood the test of time for the largest breasts. A common criticism of this technique is a boxy result and poor scarring of the transverse scar.
As for arguments from doctor to doctor, you need to compare the different techniques to understand what they are offering you. If they only perform the Hall-Findlay technique they may tell you that you need an anchor scar. While physicians trained and experienced with the Lejour technique will be comfortable offering you a lollipop incision. My advice is to check with the surgeons for the specific technique - not the specific incision. My best advice is to choose the experienced Lejour Surgeon.
If you would like more information, please read my book "Cosmetic Breast Surgery - A Complete Guide From A to Double D" or go to my website to see more on all the different techniques available.

When a lollipop technique is used with a breast reduction it is often termed a "vertical technique" breast reduction. In general, the decision of whether or not you need a scar along the fold is determined by your skin volume and how far your nipples hang down. If you have a lot of ptosis (droop) it is hard to get a good shape with a lollipop technique.

I teach courses on lollipop lifts.  If you have very large breasts then a lollipop is likely not a good choice. If you want a large reduction again this may not be a good choice.  If your breasts having very low, then a lollipop is not a good choice.  I would have to see you in person to be sure.

Undergoing breast reduction from a G cup to a C cup is a fairly aggressive change that will likely require significant skin reduction and reshaping.  I personally doubt that this could be accomplished aesthetically with a lollipop incision alone and would recommend your consideration of the anchor pattern.  During the surgical procedure the option may exist to undergo a J-mastopexy eliminating the incision under the inner aspect of your breast.  I think it is safe to say that a lollipop incision would probably be associated with a higher likelihood of the need for revision so the choice is yours.  Best wishes for good result,Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover SurgeonBeverly Hills, CaliforniaIG: jonperlmanmd