Breast Reduction Controversies – Anchor vs. Vertical Scar

Anchor vs. Vertical Scar for Breast Reduction Surgery

For women dealing with overly large, heavy breasts, breast reduction surgery can be the recommended procedure. By removing excess breast tissue, the surgery can help relieve pain in the neck, back and shoulders and even improve posture. However, the surgical approach used for breast reduction is a topic of ongoing debate within the plastic surgery community. The traditional “anchor” incision pattern has been the go-to technique for many years, but a newer “vertical” or “lollipop” incision is becoming more popular due to its potential for less visible scarring.

In this blog post, we’ll explore the pros and cons of each breast reduction approach, along with insights from Sydney Specialist Plastic Surgeon Dr Bish Soliman on which technique may be right for your particular case.

Download Dr Bish Soliman’s Guide to Breast Reduction Surgery

Ultimate Guide To Breast Reduction

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The Anchor Incision Approach

The anchor incision pattern is the classic breast reduction technique that has been used by plastic surgeons for decades. Also known as the “inverted T” or “wise pattern” incision, this approach involves three main cuts:

1. A circular incision around the areola (the pigmented area surrounding the nipple)
2. A vertical incision running down the centre of the breast
3. A horizontal incision along the breast crease

These three incisions create an anchor-like shape, hence the name. The surgeon then removes excess breast tissue through these openings and rearranges the remaining tissue to create a smaller, uplifted breast.

The anchor incision has several advantages that have made it the standard approach for many years:

• Well-Established Technique: Plastic surgeons are highly familiar with the anchor incision method, as it has been the go-to breast reduction procedure for a long time. This means they can reliably execute the surgery with a low risk of complications.
• Good Shape and Lift: The anchor incision allows the surgeon to precisely sculpt the breast into a natural, aesthetically pleasing shape with excellent lift. The horizontal incision across the breast crease, in particular, helps create a flattering contour.
• Proven Results: Patients who undergo the anchor incision technique generally achieve their desired breast size reduction and have high satisfaction rates with the outcome.

However, the anchor incision does have some drawbacks, the most significant being the potential for more visible scarring. Because of the multiple incision sites, patients are left with scars around the areola, down the centre of the breast, and along the breast crease. While these scars do fade over time, they remain noticeable, especially in certain lighting conditions or with certain styles of clothing.

The Vertical/Lollipop Incision Approach

In recent years, a newer breast reduction technique known as the vertical or “lollipop” incision has gained popularity among plastic surgeons and patients. This approach involves two main incisions:

1. A circular incision around the areola
2. A single vertical incision running down the centre of the breast

The vertical incision eliminates the need for the horizontal incision across the breast crease. This, in turn, reduces the total length of scarring.

The potential benefits of the vertical incision technique include:

• Less Noticeable Scarring: With only two incision sites (around the areola and down the centre of the breast) instead of three, the vertical technique can result in less visible scarring compared to the anchor incision. This is especially true for the horizontal scar, which is often the most conspicuous part of the anchor incision.
• Improved Breast Shape: Some surgeons and patients report that the vertical incision leads to a more perky breast shape with better lift. The lack of the horizontal crease incision may contribute to this effect.
• Shorter Recovery Time: Because the vertical technique involves fewer incisions, patients may experience a slightly faster recovery period with less post-operative pain and swelling.

Despite these potential upsides, the vertical incision approach also has some potential drawbacks:

• Technical Difficulty: Performing the vertical breast reduction is generally considered more technically challenging for the surgeon compared to the anchor incision. This is because the surgeon has less control over the breast shape and has to be extremely precise in their tissue removal and sculpting.
• Higher Complication Risk: Due to the increased technical complexity, the vertical incision technique may carry a slightly higher risk of complications like tissue necrosis (death), wound healing issues, or other problems.
• Less Predictable Results: While many patients are pleased with the aesthetic outcome of the vertical incision, the results can be less consistent and predictable compared to the anchor approach, especially for patients with very large, pendulous breasts.

Ultimately, the choice between the anchor and vertical incision for breast reduction surgery is a nuanced decision that must be carefully considered by the patient and their plastic surgeon. Factors like the patient’s breast anatomy, desired aesthetic goals, and the surgeon’s expertise all play a role.

“There are merits to both the anchor and vertical incision approaches,” explains Dr Bish Soliman. “The anchor technique is the time-tested standard that delivers very reliable, consistent results. But the vertical incision can be a good option for the right patient who is willing to accept a slightly higher risk in exchange for less visible scarring.”

Dr Soliman notes that he will often discuss both options with his patients and help them weigh the trade-offs to determine the best fit. “At the end of the day, my goal is to help each patient achieve the outcome they want, whether that’s the anchor or vertical technique. It’s all about customising the approach to the individual.”

Recovery Time and Scarring

As mentioned earlier, the vertical incision approach is generally associated with a slightly faster recovery period compared to the anchor incision.

For the anchor technique:

• Patients can expect to take 1-2 weeks off work to recover.
• There is typically moderate pain, swelling and bruising for the first 1-2 weeks.
• Most normal daily activities can be resumed within 3-4 weeks, but strenuous exercise is often limited for 4-6 weeks.

For the vertical technique:

• Patients may only need 1 week off work to recover.
• Pain, swelling and bruising tend to be a bit less intense and resolve more quickly.
• Many patients can return to most normal activities within 2-3 weeks.

The reduced number of incisions and less extensive tissue manipulation in the vertical approach contributes to this slightly faster recovery timeline. However, it’s important to note that individual recovery can vary based on factors like the patient’s overall health, extent of surgery, and adherence to post-op instructions.

Scarring
Scarring is one of the primary considerations when weighing the anchor vs. vertical incision options. As discussed earlier, the anchor technique results in three scars:

• Around the areola
• Down the centre of the breast
• Across the breast crease

The vertical incision approach leaves just two scars:

• Around the areola
• Down the centre of the breast

Patients often report that the vertical technique leads to less noticeable, finer scars compared to the anchor method. This is especially true for the horizontal scar under the breast, which can be quite prominent in some cases.

That said, scar appearance can vary significantly based on factors like the patient’s skin type, healing ability, and how well the incisions are closed during surgery. Proper scar care and massage techniques can also help minimise the visibility of scarring over time.

Ultimately, while the vertical incision generally results in less extensive scarring, patients should have realistic expectations and discuss scar management strategies with their surgeon regardless of the technique used.

Other Factors to Consider When Deciding Between the Anchor and Vertical Incision Techniques

Here are some other factors you should consider when deciding between the anchor and vertical incision techniques for breast reduction surgery:

• Breast Size and Shape
  The vertical incision technique generally works best for women with moderately large, pendulous breasts. For those with extremely large, heavy breasts, the anchor incision may be a safer, more reliable option. The anchor approach provides the surgeon with better control over achieving the desired breast size and shape.
• Future Breastfeeding Plans
  Women who plan to breastfeed in the future may want to opt for the anchor incision, as it tends to preserve more of the breast’s natural tissue structure and milk ducts. The vertical technique can sometimes interfere with the ability to successfully breastfeed.
• Existing Breast Ptosis (Drooping)
  Patients with significant breast ptosis (drooping) may achieve better long-term lift and shape with the anchor incision, which allows the surgeon to reposition the nipple-areola complex higher on the chest wall.
• Skin and Tissue Elasticity
  Women with good skin and breast tissue elasticity are generally better candidates for the vertical incision, as it relies more on the natural reshaping of the breast. Those with less elastic tissue may be prone to issues like persistent fullness at the breast crease with the vertical approach.
• Surgeon Experience and Preference
  Ultimately, the surgeon’s own skill, experience and preferred techniques will play a large role. Patients should choose a plastic surgeon who has extensive expertise performing both the anchor and vertical incision breast reductions.
• Recovery Priorities
  Some patients may prioritise a slightly faster recovery time and less visible scarring, making the vertical incision more appealing despite the increased technical demands. Others may favour the more established, predictable results of the anchor approach, even with the trade-off of more scarring.

FAQs about Breast Reduction Anchor vs. Vertical Scar

Which technique preserves more breast sensation?

• The vertical incision technique is generally considered better for preserving nipple and breast sensation compared to the anchor approach. This is because the vertical method involves less extensive tissue dissection and manipulation around the breast nerves. However, some degree of temporary or permanent numbness is a risk with both techniques.

Are there any differences in the risk of complications?

• Both the anchor and vertical incision methods carry similar overall risks of potential complications, such as bleeding, infection, poor wound healing, and the need for revisional surgery. However, the anchor technique may have a slightly higher rate of complications like nipple/areola necrosis due to the more complex tissue rearrangement.

How long do the surgical results typically last?

• The long-term durability of results is comparable between the two techniques when performed by an experienced plastic surgeon. However, patients with significant breast sagging may experience a faster recurrence of ptosis over time with the vertical incision method compared to the anchor approach.

Can the vertical technique be performed for very large breasts?

• While the vertical incision is best suited for moderate to large breast sizes, it can sometimes be used for extremely large, pendulous breasts as well. However, the anchor approach is generally considered the safer and more reliable option for patients with excessively large, heavy breasts that require extensive tissue removal and reshaping.

Is one technique more expensive than the other?

• The surgical fees for anchor and vertical breast reduction are typically very similar when performed by the same plastic surgeon. Any slight cost differences would mainly come down to factors like the complexity of the individual case, operating room time, and the specific surgical facility. Patients should always obtain a detailed cost estimate from the surgeon.

Further Reading about Breast Reduction Surgery with Dr Bish Soliman

• Read Dr Bish Soliman’s Blog about FAQs about Breast Reduction (Reduction Mammaplasty)
• Read Dr Bish Soliman’s Blog about How to Prepare for Breast Reduction Surgery
• Read Dr Bish Soliman’s Blog about Reducing Bruising after Breast Reduction
• Read Dr Bish Soliman’s Blog about Medicare for Breast Reduction Surgery in Sydney
• Read Dr Bish Soliman’s Blog about Getting Back to Exercise After Breast Reduction Surgery

Medical References about Breast Reduction Scars

• Incisions made for breast reduction surgery – Mayo Clinic
• Breast Reduction – an overview – ScienceDirect.com
• Unfavourable results following reduction mammoplasty
• Periareolar reduction mammoplasty using an inferior dermal pedicle or a central pedicle
• Superior Pedicle Breast Reduction with Prefiguration of Final Shape