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CosmeticSurg Blog

Dr. Rodriguez discusses Plastic Surgery, Medicine, and Stem Cell Research

Breast Surgery: What type of scar do I get with different breast techniques?

Breast Scar Comparison for various techniques

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 Benelli 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. The Wise Pattern 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 still in wide usage by Plastic Surgeons.

Vertical scar (Lollipop scar, Lassus technique):

The Vertical scar 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.

Benelli scar (Periareolar scar):

The Benelli 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 sewn into the smaller circumference of the areolar complex. However, with the correct sutures, I love this technique.  After the surgery,  the scars around the nipple fade well so that a year later you can hardly see them.

Crescent scar:

The Crescent technique 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 Benelli 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 Benelli scar. If postoperatively the breast tissue slides down on the implant, I will consider lifting the nipple areolar complex more, or coverting to a Benelli. 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 Types of Breast Scars, please post them here!

By Ricardo L Rodriguez MD
Board Certified Plastic Surgeon
Baltimore, Maryland
©Cosmeticsurg.net (permission to link to article with original source URL only)
Ricardo L Rodriguez on Google +

Posted in Breast

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24 Comments

  • wrote
    November 7, 2013 at 10:22 pm

    Alicia:
    Please call us, there are plenty of options.
    We do this a lot. You can get a lift with a scar just around the areola, I repeat we do it ALL THE TIME.
    And you may also be surprised at our prices.
    Contact Kelly at kelly@cosmeticsurg.net we’d love to see you!

  • wrote
    November 7, 2013 at 9:08 pm

    I just saw Dr Adam Basner today and we had agreed to do an augmentation with a lift that would leave a vertical scar. 360 cc silicone. My concern was the obviously the scarring.. I did not know there were other options that would minimize the amount of scarring. I was also concerned about any desensitization since the incision is around the areola. Could I be a candidate for the crescent approach? I am 26 yrs old. 5’1″, 120 lbs. Dr Basner said there would be no way I would get desirable results without a lift. Thank you in advance for your advice!

  • wrote
    September 19, 2013 at 12:00 pm

    Janette:
    The areola is composed of muscle underneath and skin on the surface. The muscle can stretch. Normal skin however has dermis underneath which is much less stretchable. So if you do a Bennelli mastopexy the areola will expand, as it does in a Benelli mastopexy.
    If you want more information we’d be glad to help you out. Contact Kelly at kelly@cosmeticsurg.net

  • wrote
    September 16, 2013 at 5:52 pm

    I am considering a breast lift. I have very small hardley there nipples, is there a procedure that makes nipples larger?

  • wrote
    March 31, 2013 at 6:43 pm

    Sehena:

    Read this post to see the different scars.
    Of course, a lot depends if you are having a breast implant or not. Read this post to help you decide.
    Implants change the relationship between the skin envelope and the breast tissue. The larger breast implant, theoretically the least scarring you should need.
    In the ultimate analysis, the only scar you should need should be the scar around the areola, because you need to raise the areola to its proper position above the inframammary fold.
    To see pictures of areolar scars, go to our gallery page of Breast lifts.
    Give us a call if you have questions!

  • wrote
    March 10, 2013 at 1:49 am

    Hi doctor,

    I have had saggy breasts all of my life. Even in my teen years. My question is, which surgery will cause the least amount of scaring? Also is there any procedure that can remove scaring all together? I’m not really fond of scars. Then again, I doubt that many people are.

  • wrote
    June 27, 2012 at 1:15 pm

    Denise:
    It is not that unusual for breast size to change after pregnancies. In your case they got bigger, although that can also be influenced by overall gain in weight if that also happened after pregnancies.
    I think getting a smaller implant combined with a Benelli lift is a good idea. In the case of a straight breast lift or reduction a Benelli lift can make the breast appear flat, but the implant is silicon in a sell that holds the shape of the breast.
    We do this a lot. I hope this helps, but to make more specific recommendations I think it wold be a good idea to do a virtual consultation.
    Lokking forward to it!

  • wrote
    June 26, 2012 at 10:49 pm

    Dr Rodriguez,
    Hello, I have had implants for about 10 years now–went from 34 A/B to 34 D. After having 2 children am now 34 DD. I am really feeling top heaving (5’2 and 120 lbs) and would like to go to a smaller implant size of 34 C. I have had a few consultations and have heard that this surgery is not possible and would leave my breasts looking worse, I would be unhappy. And second recommendation was implant replacement with a C using a Benelli lift.
    I have read that the Benelli leaves breast looking like a pancake?? Wasnt sure what that meant and that the best type of lift for a reduction and optimal result would be a vertical. Am feeling overwhelmed and confused and would like your recommendation on this.
    Is a virtual conference available though video, Iphone?

  • wrote
    October 30, 2011 at 2:49 pm

    Madge:
    I have been doing Vertical scar breast reductions for over 20 years. My personal record is 3KG (6.6 pounds) per breast. The technique, done correctly, does not need any other gimmicks such as a laser bra lift.
    The issue of “drop out” is related to how well you execute the balance between skin and glandular tissue. Many surgeons have particular problem getting that right with vertical scar breast reduction, which is why they say vertical scar does not work on large breasts. Do not believe it.
    A vertical scar breast reduction gives you a rounder, perkier bread with less scars.
    Get it, you won’t be sorry.
    Contact Kelly at kelly@cosmeticsurg.net for more info

  • wrote
    October 16, 2011 at 7:56 am

    Is it possible to get a vertical scar breast reduction for a reduction coming from a 42 DDD to a 42 D with an added mastopexy with a laser Bra Breast lift?

  • wrote
    March 29, 2011 at 9:42 am

    Marylin:
    The right time is not defined, but if your daughter has stopped growing, now is a good time, before she gets a too self conscious all the time. I personally think during the dating years it’s very important for a young woman to feel comfortable with herself. I would love to help her, contact Kelly if you want more info at kelly@cosmeticsurg.net.
    I think a combination of implant or fat injections with a breast lift would do wonders for both the appearance of the breasts and her self confidence. By the way, I don’t think you need a vertical scar or a “T” or “anchor” scar is needed. Everything can be done thru the areola reduction incision.
    BTW, re your last name, is it Padilla? My grandmother’s maiden name was Padilla. My dad was therefore Ricardo Luis Rodriguez-Padilla because in P.R. we keep our mother’s last name.
    For example, even though my son and I have my father’s name (Ricardo Luis), we are all distinguished by the mother’s maiden name. My mother’s maiden name was Lugo but I always thought the Padilla side of the family were the coolest.
    Anyways, give my best to your daughter, and tell her there is a solution!

  • wrote
    March 28, 2011 at 5:42 pm

    My daughter will be 17 in April of this year (2011). She has what you have described as tube shaped breast. Long tube like and set far apart on her chest. She struggles with her self esteem and is very embarassed by them. It is also very difficult to find a bra that even gives her an acceptable appearance. She started showing signs in her early development. I had hoped as she got older they would develop into a more round shape but that hasn’t happened. At what age is it appropriate to consider plastic surgery to correct the deformilty?

  • wrote
    December 23, 2010 at 1:41 pm

    Hello Joanna,

    Thank you for your interest in a virtual consultation with Dr. Rodriguez. This consultation can be done by phone, iChat or Skype, please let me know your preference? Please know that all correspondence is strictly confidential. The photos displayed at our web site and in our office have been authorized in writing by each individual. We highly respect the privacy of your photos and your health care information. First step is to email your photos along with some information to preconsult@cosmeticsurg.net.

    Please take just body photos from right below your chin to your waist, make sure to put your hands on your hips so that your entire torso can be seen:
    1. Front view
    2. Right side (profile)
    3. Left side (profile)
    4. Front right oblique angle (quarter turn)
    5. Front left oblique angle (quarter turn)

    Please send the following information to process your appointment:
    1. full name –
    2. phone number –
    3. address –
    4. date of birth –
    5. brief medical history –
    6. previous cosmetic procedures –
    7. do you smoke –
    8. current medications –
    9. allergies –
    10. any other information that you would like Dr. Rodriguez to know about you –
    11. Credit Card information for your virtual consultation will be taken at the time we recieve your call (we will not apply charges until you speak with Dr. Rodriguez)

    Happy New Year!
    Best regards,
    Kelly Warner
    Patient Coordinator
    Ricardo Rodriguez, MD
    410-494-8100

  • wrote
    December 21, 2010 at 10:33 pm

    Joanna:
    I already answered your previous entry, if you contact Kelly she can arrange for a virtual consultation where I review pictures, etc. We can Skype also.
    I have not done a Wise pattern in many years because I think it is too much scarring, and it makes the breast flatten out.
    The Wise pattern takes out a lot of skin, which is OK (not great) if you want a lift only, because you have an excess of skin relative to breast tissue. In these cases a Lollipop scar does better because it centralizes breast tissue, much like a wire rim bra does. And it has less scars than a Wise!
    When you add volume with an implant, you don’t need to take out as much skin. That is why I prefer a Benelli in these cases.
    I can’t tell you what to do, but I can tell you I do a lot of Breast lift/Augmentations with a Benelli and it is the best combination of beauty with minimal scars.
    Come see us!

  • wrote
    December 21, 2010 at 10:24 pm

    Joanna:
    Contact Kelly at kelly@cosmeticsurg.net so we can set up a consultation.
    We’d love to hear from you!

  • wrote
    December 19, 2010 at 10:50 am

    Hi Doctor. I just got my implant deflated because they were to saggy and i want a breast lift with a new implant. I had my implant above the muscle. Now that my implants are deflated i can see more of my natural boobs. They are very saggy. I have schedule my surgery for febuary 7th but reading your post im considering a virtual consultation with you. Can you send me before and after pictures and can you perform a crescent with maybe some benelli? I have before and after pictures, if you need to see. Where i am going they are performing a Wise. What do you recomend?

  • wrote
    December 19, 2010 at 10:38 am

    Im interested in a breast lift with implant.

  • wrote
    November 10, 2010 at 10:17 pm

    I love your blogs. Very informative.

  • wrote
    October 10, 2010 at 8:47 pm

    Monique:
    You can do a lift with a scar just around the areola. It is hardly visible as it is the border of areola and normal skin. You do not need any other scar.
    If you are interested in how we do it, call our office and one of the staff will be able to help you. Ask for Leeza or Kelly. Our phone number is (410) 494-8100
    You can also set up for a virtual consultation with me, but there is a procedure to follow which involves sending pictures, setting up a time, etc.
    We’d love to hear from you and I’m sure we can handle your situation.

  • wrote
    September 21, 2010 at 12:31 am

    I just got my implants july 1st. I am 25 yrs old and have two kids. So from having my kids I had saggy boobs. My doctor put my implants over the muscle without a lift. I’m very unhappy how they look. I want him to go back and do a lift but I’m scared for the scaring. I also want him to go under the muscle for more support I need a secound umpinoun plz. What would you do if I was your patient. I’m just so sad about it.

  • wrote
    August 11, 2010 at 12:11 pm

    Anna:
    It is impossible to give you an educated opinion without seeing pictures. Generally speaking, fullness in the upper part of the breast is extremely hard to get without implants. The reason is that although in the beginning a breast lift may look full up top, as the skin relaxes, the fullness drifts down.
    Since the implant is held by a scar capsule that is adherent to the chest wall and muscle, it tends to say in place.
    Because of this, on some patients you end up taking some breast tissue from the bottom of the breast and adding an implant at the upper pole of the breast.

  • wrote
    August 9, 2010 at 4:56 am

    Hi doctor. I am 18 years old and I have pretty saggy breast and Its seems like I have had them since I began to develop. Theres always been a lack of fullness on the upper portion that never filled out during development. I’m satisfied with size of my breast since I’m a 34 D but I would like a lift and a fuller appearance especially up top. Would I be a candidate for breast lift with out implant or would implants be necessary.

  • wrote
    February 8, 2010 at 4:34 pm

    Elsa:
    Yes. of course.
    We have done this on several cases. I do find that most patients want a little of fullness above the areolar area, and for this you need an implant.
    If you are happy with your size, and you don’t expect fullness in the upper pole of the breast, you will do great with just a crescent or a Bennelli.
    Best Wishes!

  • wrote
    February 6, 2010 at 5:27 pm

    Hi Dr. Roderiguez. My question is, can the Bennelli and Crescent techniques be used on breasts without implants? I’m concerned about the scars the other techniques leave.

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  2. [...] the lower pole of the breast, when you need all the skin you have. The perfect solution then is the Bennelli breast lift, or  Donut mastopexy. It reduces the areola size and gets rid of the least possible amount of [...]