What’s the best technique for breast reduction surgery?

Is one technique or incision type better than the other? Or does it just depend on the person? I always get confused when reading through different things on the internet, since there’s sooo much out there. I really just want an easy to understand breakdown of the pros and cons of each. I really appreciate any help here!

Krisstina

F, 47, New Jersey

As with any other type of plastic surgery, there is no one-size-fits-all answer when it comes to breast surgery.

The term breast reduction, sometimes referred to as mammoplasty, reduction mammaplasty or reduction mammoplasty, actually encompasses many different techniques. The right surgical procedure depends on factors that are unique to your specific situation, such as your breast size and shape and how dramatic you want the results to be.

For example, if you have mild ptosis (drooping) and desire a modest reduction, a less invasive surgical technique mostly consisting of liposuction may be sufficient.

If you have moderate ptosis, a breast reduction procedure involving a “lollipop” incision (around the nipple-areolar complex and down to the crease of the breast) may be best.

 

And if you have severe ptosis and want a lot of lift, a procedure involving a standard incision will probably work best.

Dr. Kimberly Henry has 2 Breast reduction before & afters:

Breast reduction before image performed by Dr. Kimberly HenryBreast reduction after image performed by Dr. Kimberly HenryBreast reduction before image performed by Dr. Kimberly HenryBreast reduction after image performed by Dr. Kimberly Henry

» View Dr. Kimberly Henry's full profile

It depends on your individual anatomy and goals, but the most popular breast reduction techniques are those involving the Wise Pattern (a.k.a. anchor) incision and the vertical scar (a.k.a. lollipop) incision.

The Wise Pattern technique, also known as the anchor incision, T-scar, T-incision or inverted-T incision reduction, has been around the longest and is the most common breast reduction method. This incision pattern involves an incision around the areola and then down to and across the bottom of the inframammary crease (breast crease). It is most suitable for women with overly large breasts and significant ptosis. Unfortunately, this method does produce noticeable scars.

 

The vertical technique, more commonly known as the breast reduction lollipop technique (and, less often, keyhole incision breast reduction, circumvertical, and Le Jour incision reduction) entails an  incision around the areola and down to the inframammary fold, but not across the bottom edge of the breast.

This type of vertical incision, which is also used during breast lift procedures, is best for women that don’t need a large amount of breast tissue (fat tissue and glandular tissue) removed.

The nice thing about a vertical incision breast reduction is that, since the incision does not extend to the bottom edge of the breast crease, it doesn’t involve as much scarring. The vertical breast reduction technique is an effective way to reposition and lift the nipple-areola complex that may be somewhat low.

The J-breast reduction falls between the vertical reduction and anchor reduction, creating a vertical scar pattern that extends only to the outside of the breast crease by not toward the inside.  The J reduction is also very effective at lifting a low breast, but in many cases creates a better shaped breast than a vertical reduction when there is significant excess skin.

One more thing: all breast reduction techniques may have some risk of numbness due to the need to lift the nipple and make an incision around it. However, permanent numbness is uncommon.

Great question!

Here's the breakdown. I am specifically excluding from this discussion the kind of "liposuction-only" breast reduction that some surgeons offer. That technique can reduce volume in the breast but often results in a deflated appearance as it does not address lifting the nipple or tightening the skin/removing extra skin.

For all other surgical breast reduction techniques, there are some common requirements:

  1. Every breast reduction needs at least an incision around the nipple/areola. This is because we lift the nipple during reduction and it also gains us some access to the deeper tissues around the sides of the breast. 
  2. Most breast reductions also include a vertical incision as this helps to remove extra skin left-right along the breast, and when combined with the circle around the nipple, can help lift and reshape. The challenge with this technique is the breast can look a bit top-heavy in the beginning until it settles, and also that this technique is limited in its ability to shorted the under-curvature length of the breast for very large, pendulous breasts. When you hear about a "vertical breast reduction" you are usually hearing about the technique that combines this vertical incision with the peri-areolar (circle around nipple/areola). Many surgeons prefer this technique in order to avoid the horizontal scar in the fold under the breast. However, as stated above, there may be a "long lower pole" of the breast after settling with this technique because it is the horizontal scar that lets you shorten the vertical distance of the bottom of the breast.
  3. The full anchor pattern (also known as "Wise" pattern) includes the above plus the horizontal incision and in my opinion gives the most flexibility for the surgeon to control breast shape. One of the criticisms some surgeons have of this technique is this: because it is usually combined with an internal approach that keeps the nipple blood supply coming from the bottom of the breast (known as the inferior pedicle), there can be a "bottoming out" of hanging of the breast in the long term. This depends on a lot of factors, though, and is probably not actually specific to the Wise-pattern approach.
  4. The actual incision pattern can be a combination of the above - for instance, some surgeons try to avoid the vertical scar altogether with a "no-vertical-scar" reduction. This is a more challenging technique and may have issues regarding the skin quality during healing and is not commonly done.
  5. I think getting a good shape to the breast and the appropriate amount of volume reduced is more important than the scar pattern itself.

If you'd like to see some visual diagram explanations of the incisions, check out or breast reduction page here:

http://www.timsayedmd.com/breast-plastic-surgery-newport-beach/breast-reduction/

A full in-person consultation is required for comprehensive advice for a specific patient but this is a good guideline. We are happy to help!

-- Dr. Sayed

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