Why Vertical Breast Reduction Used to Be Hard

For many years, the Vertical Reduction Mammaplasty (often called the “Lollipop” reduction) struggled to gain popularity in North America. Surgeons worried that the technique was too difficult to learn. Many also believed it only worked for small breast reductions.

Dr. Elizabeth Hall-Findlay changed this perspective. In her influential study published in Plastic and Reconstructive Surgery, she introduced modifications that made the procedure simpler, safer, and more reliable for all sizes.

Four Key Modifications That Simplified Everything

Dr. Hall-Findlay identified several steps in the traditional “Lejour” technique that made it complicated. She simplified the surgery by focusing on these four changes:

1. The Medial (or Lateral) Pedicle

Instead of using a complex central blood supply, she used a medial or lateral dermoglandular pedicle. This tissue bridge safely carries the blood supply to the nipple. This change makes the move (transposition) of the nipple much more predictable for the surgeon.

2. No Skin Undermining

Traditional methods often involved “undermining” or separating the skin from the underlying breast tissue. Dr. Hall-Findlay removed this step. By keeping the skin attached, the breast retains better blood flow and heals more reliably.

3. Minimal Use of Liposuction

While some techniques rely heavily on liposuction to reduce breast volume, Dr. Hall-Findlay found it was rarely necessary. She preferred direct surgical removal to ensure a more precise and stable breast shape.

4. No Pectoralis Fascia Sutures

She eliminated the need to stitch the breast tissue to the chest muscle (pectoralis fascia). This streamlined the operation and reduced internal complexity.

Proven Results: 400 Successful Cases

Dr. Hall-Findlay tested these modifications in a series of 400 vertical breast reductions. The results proved that the “Lollipop” method isn’t just for small breasts.

• Broad Application: The average reduction was 525g per breast, but she successfully removed up to 1425g using this technique.
• Reduced Scarring: By using a vertical pattern, she effectively eliminated the long horizontal scar found in traditional “Anchor” reductions.
• Ease of Use: The study concluded that these modifications made the technique much easier for other surgeons to learn and apply.

The Takeaway for Patients

If you want a breast reduction with less scarring, you no longer have to worry if your breasts are “too large” for a vertical technique. Thanks to these refinements, surgeons can offer the “Lollipop” reduction with high safety and excellent, long-lasting results.

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Frequently Asked Questions

Q: Is the vertical technique safe for very large breasts?

A: Yes. Dr. Hall-Findlay’s research showed it is effective for reductions involving over 1400g of tissue per breast.

Q: What is the main benefit of the medial pedicle?

A: It provides a very reliable blood supply to the nipple and areola, which reduces the risk of healing complications.

Q: Will the “Lollipop” shape hold up over time?

A: Because this technique uses internal tissue shaping rather than just skin tightening, the results tend to be very stable.

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Reference

[1] Hall-Findlay, Elizabeth J. M.D., F.R.C.S.(C). “A Simplified Vertical Reduction Mammaplasty: Shortening the Learning Curve.” Plastic and Reconstructive Surgery 104(3):p 748-759, September 1999.