The best incisions used for a breast reduction are determined on a case-by-case basis. All breast reductions require an incision around the nipple and areola, which lifts the nipple to a higher position and often reduces the diameter of a very large areola to one that is more proportionate to the breast. Breast reductions also require the creation of a vertical incision that extends from the bottom of the areola to the breast fold. See the image below.

If a woman is obese – particularly with a wide breast base and a significant amount of breast tissue and fat that extends around to her back – we may need to “chase” this back fat / breast roll around to the back, resulting in a longer scar in the fold of the breast. This is often called the “anchor scar,” which resembles an anchor shape.

Other women with a narrow breast but more droop may get away with fewer incisions, often avoiding a long scar in the fold of the breast. If only the circular incision around the areola and vertical incisions are used, this is often called the “lollipop” scar. However, many women who are appropriate candidates for breast reduction surgery are not candidates for this incision design, as it does not adequately reshape and reduce the breast in most instances.

The technique used most commonly in my practice is called the “superomedial pedicle” technique, which refers to the direction of blood supply, ductal supply, and nerve supply to the nipple and areola. This method combines a lollipop scar with a short scar hidden in the natural fold under the breast. Incisions will be hidden in most undergarments after surgery, including a triangle bikini top.

– Karen Horton, MD

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