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The Vertical “Lollipop” Scar: Now for Large Breasts – Breast Reduction

Can Large Breasts Have Smaller Scars?

In the past, patients with very large breasts (resection weights over 700g) were almost always given an “Anchor” scar. Surgeons believed the Vertical (or “Lollipop“) technique only worked for small reductions. They feared that the vertical scar would not be strong enough to hold the weight of a larger breast over time.

However, a massive study published in Plastic and Reconstructive Surgery has changed that thinking.

Researchers analyzed 500 breast reductions in 250 overweight patients. The research was conducted in Ulm, Germany, and Padova, Italy. They used a modified version of the “Lejour Technique” to prove that large breasts can achieve excellent results with fewer scars.

The Modifications: Making the Vertical Technique Stronger

The standard vertical technique can be difficult for large breasts. Therefore, the authors introduced several key modifications to make it more reliable.

1. Central Undermining (No Liposuction)

Instead of using liposuction to reduce volume, the surgeons used a “step-wise” surgical approach. They moved the tissue centrally and atraumatically. This preserves the best possible blood supply to the skin and nipple.

2. The “Three H Points” Fixation

This is the most critical part of the modification. A common problem with vertical reductions is “bottoming out.” This happens when the breast tissue sinks over time, making the bottom of the breast look too heavy.

To prevent this, the surgeons fixed the submammary fold (the crease under the breast) using three H points. These points act as a “pivot.” They anchor the internal tissue so it cannot sag later.

3. Adjusted Pleated Sutures

The vertical scar is often “pleated” or gathered during surgery. The authors adjusted this technique to match the specific retraction ability of the patient’s skin. For very large reductions, they occasionally combined it with a small horizontal line to ensure a smooth finish.

The Results: 94% Success Rate

The study tracked 250 patients for an average of 4.2 years. This long-term follow-up is important to see if the shape holds up.

  • Large Reductions: The average tissue removed was nearly 1,000g per breast (over 2 lbs).
  • Patient Outcomes: 94% of patients rated their results as “Very Good” or “Good”.
  • Safety: The complication rate was 14%, which is comparable to traditional techniques.

Conclusion: A New Standard for Large Breasts

This research proves that the vertical technique is no longer just for “small” cases. It is a highly effective standard technique for larger breasts.

By using the “Three H Points,” surgeons can simplify the technique while reducing the visible scarring. If you have been told you are “too large” for a vertical reduction, this study shows that a modified approach can offer the smaller scar you want with the stability you need.

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Contact us to know if you are a suitable candidate for Breast Reduction.

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Frequently Asked Questions (FAQ)

Q: Does this technique work if I am overweight?

A: Yes. This study specifically looked at overweight patients with an average resection weight of over 900g per breast.

Q: Will the “pleated” scar look bumpy?

A: Initially, the vertical scar may look gathered. However, the study adjusted the sutures to the skin’s natural ability to retract. Over time, these lines typically flatten and fade significantly.

Q: What is the main benefit over the “Anchor” scar?

A: The primary benefit is the reduction of aesthetic deficiencies. You avoid the long horizontal scar across the chest, resulting in a more natural look in clothing and swimwear.

Reference

Hofmann, Albert K. M.D.; et al. “Breast Reduction: Modified ‘Lejour Technique’ in 500 Large Breasts.” Plastic and Reconstructive Surgery 120(5):p 1095-1104, October 2007.

Breast Reduction, Gigantomastia
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The Hall-Findlay Technique: Simplifying the “Lollipop” Breast Reduction

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.

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.

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.

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A Safer Breast Reduction for Smokers? The “Three Flap” TechniqueThe Risk: Why Surgeons Turn Smokers Away

The Risk: Why Surgeons Turn Smokers Away

If you smoke or have a higher Body Mass Index (BMI), finding a surgeon for breast reduction can be difficult. Many surgeons hesitate to operate on these “high-risk” patients.

The reason is simple: Blood Supply.

Nicotine shrinks blood vessels. This limits the oxygen reaching the healing tissue. In breast reduction surgery, this increases the risk of serious complications, specifically nipple necrosis (where the nipple tissue dies) or wound breakdown.

However, a study published in Plastic and Reconstructive Surgery presents a specialized technique designed to overcome these odds.

The Solution: The Three Dermoglandular Flap Technique

Surgeons from the University of Bari, Italy, developed a method specifically for challenging cases. They call it the Three Dermoglandular Flap technique.

How It Works

Standard reductions often rely on skin to hold the breast shape. Over time, skin stretches, and the breast droops again (recurrence).

This Italian technique uses a different approach:

  1. Inferior-Central Pedicle: The surgeon keeps the nipple attached to a robust central bridge of tissue to ensure maximum blood flow.
  2. Internal Support: They create three separate flaps of dermis (deep skin) and gland tissue.
  3. The “Internal Bra”: These flaps are stitched together inside the breast. This creates a strong internal structure that supports the weight of the breast, independent of the skin.

The Test: Operating on “High-Risk” Patients

The researchers tested this method on the hardest-to-treat group. They selected 47 women who met strict criteria:

  • They were all smokers.
  • They had massive breasts (volume >1000 cc).
  • They had severe sagging (Grade 3 Ptosis).
  • They were overweight (Average BMI of 31.2).

The Results: Zero Nipple Loss

Given the high risks, the results were remarkable.

  • Safety: There were zero cases of partial or complete nipple necrosis.
  • Healing: There were zero cases of major wound breakdown.
  • Aesthetics: The technique produced a good cone shape with fullness in the upper breast.
  • Longevity: The results remained stable over time (up to 4 years of follow-up), proving the “internal support” worked.

What This Means for You

If you have been told you are “too high risk” for surgery due to smoking or weight, do not lose hope. While quitting smoking is always the best option for your health, surgical techniques exist that can handle challenging anatomy safely.

The Three Dermoglandular Flap technique offers a “safe and practical approach” for heavy, pendulous breasts. It prioritizes blood supply and structural support, ensuring you get the relief you need without the complications you fear.

Reference

[1] Pascone, Michele M.D.; Di Candia, Michele M.D.; Pascone, Christian M.D. “The Three Dermoglandular Flap Support in Reduction Mammaplasty.” Plastic and Reconstructive Surgery 130(1):p 1e-10e, July 2012.

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#BreastReduction #PlasticSurgerySafety #SmokersSurgery #HighBMISurgery #BreastLift #MedicalResearch #SurgicalInnovation #MassiveWeightLoss #ReconstructiveSurgery #PatientEducation

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