Breast Scar Comparison for various techniques

I have been looking at some of the breast implant forums, and there are a lot of issues related to the scars. It seems most surgeons use the Wise pattern, or Anchor scar, and some use the Bennelli scar. A few use the Vertical scar or the Crescent scar. I use all of them, except the Wise pattern scar. I feel that this technique makes unnecessary scars.

When doing a breast lift, you want to remove as much skin as necessary to tighten up the breast tissue and lift it on the chest wall. The skill of the surgeon comes in determining how much skin to take leaving as few scars as possible. If we are adding an implant, we are filling up the breast skin envelope, so less skin should be taken out than for just a lift.

So that you can better understand the 4 types of breast techniques and their resulting scars, I have made an illustration to show the amount of skin which is removed (on the left) with the resulting scar (on the right). Here is the description of the techniques:

Wise pattern (Anchor scar, Inverted T scar):

As you can see from the illustration, this skin excision pattern removes the most skin. It also leaves the most scars. In my opinion, it removes too much skin. I don’t use this technique, even in breast reductions, where we are taking out tissue. When you take out so much skin that the breast skin envelope barely covers the breast tissue, scars can get thick, or the horizontal scar may ride up on the breast as abdominal skin is used to cover breast tissue.Then there is the issue of the horizontal scars–who would want a horizontal scar which flattens out the breast?

When this technique is used for a breast lift with an implant, your degree of difficulty increases a lot, because you need more skin . Some surgeons can get good results with this Wise Pattern technique, but after 20 years in practice I believe there are ways to do it with less scars. Surprisingly, this Wise Pattern technique is in wide usage by plastic surgeons.

Vertical scar (Lollipop scar, Lassus technique):

This is my favorite technique for breast reduction, and for mastopexy without breast augmentation. It is great for giving the breast a nicely rounded shape. In breast lift with implants I use it when the top of the nipple areolar complex is below the crease of the breast (inframammary fold) and the implant is not large. With a larger implant, the implant itself gives shape to the breast mound, so there is less need for the vertical scar. It has the advantage that it can easily be revised under local anesthesia if you want some more tightness at the bottom pole of the breast.

Bennelli scar (Periareolar scar):

The Bennelli scar goes around the nipple areolar complex. I use it most for breast lift with implants and it works well for me. However, I use special type of sutures to avoid pleating in the nipple. When using traditional sutures with this technique there can be a lot of creasing of the skin, much like small pleats in a skirt, as the larger circumference of the skin excision is sown into the smaller circumference of the areolar complex. The use of Quill barbed sutures has eliminated this problem for me and I get good results with this technique. If too much skin is taken out, the areola can get stretched out. Both the skin creasing, and the stretching out of the areola can be corrected later under local anesthesia. Postoperatively the scars around the nipple fade well so that a year later you can hardly see them.

Crescent scar:

This is my favorite for Breast Lift with implants. I start out with a crescent excision then add the implant. This is sufficient in most cases. In order to prevent deformation of the areola, I use a Bennelli type suture technique that goes in and out on the bottom part of the areola (which hasn’t been cut). If I need to take out more skin I convert to a Bennelli scar. If postoperatively the breast tissue slides down on the implant, I will consider lifting the nipple areolar complex more, or coverting to a Bennelli. Both can be done under local anesthesia. It is much easier to correct by taking out a little more tissue later on than to compensate for lack of skin because too much was taken out. This technique gives me a great result with a minimum of scars.

If you have any questions about these different types scars you can e-mail me at drrodriguez@cosmeticsurg.net

Ricardo L Rodriguez, MD