THE MOST COMMON TYPES OF BREAST REDUCTION INCISIONS
There are two main options for incisions. I both cases these incisions fade greatly over time and, although present, are usually not very evident after fully healed.
The lollipop incision is a great way to limit the scars in smaller breast reductions. This incision pattern has an incision around the nipple and downward to the infra-mammary fold. This eliminates the incision running horizontally underneath the breast. Unfortunately, not all women are candidates for this incision pattern. It does not allow for as much skin removal as the anchor incision and therefore is not a great choice in larger reductions.
A ‘lollipop’ incision around the areola and vertically down to the breast crease.
This incision is the most common incision for breast reductions. This include an incision around the nipple, extending downward to the inframammary fold, and also across underneath the breast. This incision pattern is the best at addressing the extra skin associated with larger breasts. It allows the greatest removal of skin, which facilitates the greatest improvement in shape. Most breast reductions covered through an insurance policy have a minimum amount of breast tissue to remove. This is usually a relatively high quantity and requires a fairly large amount of skin removal to obtain balance and achieve a natural look.
RAISING THE NIPPLE TO A YOUTHFUL POSITION
In all breast reductions the nipple is raised to a higher and more youthful position on the breast. The breast is narrowed and the breast is raised on the chest wall to a higher position. The incisions will depend on each patient’s specific anatomy. In smaller patients with less tissue to remove, the incision will be a “lollipop” incision around the nipple and down to the base of the breast. In larger reductions, where more skin needs to be removed, the planning also requires an incision across the base of the breast, “inverted T” or “anchor” incision. A pre-determined amount of tissue and skin are also removed and the nipples are repositioned. If required, excess fat is removed using a liposuction technique.
DIFFERENCES IN THE TYPES OF BREAST REDUCTION AVAILABLE
There are two main types of breast reductions, and one less common type. The types are based on the location of the tissue (including blood supply and nerves) that is left in place underneath the nipple.
We performs nearly all of his breast reductions using this newer technique (also called the “vertical” breast reduction. This technique keeps tissue from above and medial of the nipple to support the nipple and areola after the operation. This allows breast tissue to heal to breast tissue on the bottom of the breast. The benefits are that the blood supply to the nipple is better and the risk to the nipple is less. There is less issue with poor healing of the incisions, and this technique has less long term sagginess to the breasts. This incision allows allows the small lollipop style incisions.
In this method, a band of tissue from the bottom of the breast supports the nipple. This band of tissue is generally longer, and therefore has less blood supply to the nipple than the superior-medial technique. The inferior pedicle also has a much higher rate of poor healing of the incisions. Finally, after healed the overlying skin provides the strength to the shape of the breast. Unfortunately, this is not as strong as the breast tissue, and this technique is more likely to “bottom out” as the skin stretches. There are rare circumstances when this may be the better option. This type of breast reduction requires the anchor style incision.
This operation is reserved for a small percentage of women who have “very” long breasts. In this situation, the blood supply to the nipple after a breast reduction would be so reduced that the nipple could not survive. In this circumstance, the nipple is removed from the breast and replaced as a graft. This has several negative effects, and therefore is not a preferred option. We perform one to two of this type annually. The anchor style incision is used with type of breast reduction.