Surgical Techniques
How Breast Reduction Surgery Is Performed
Breast reduction surgery (reduction mammaplasty) removes excess breast tissue, skin, and fat while reshaping the breast mound and repositioning the nipple-areola complex (NAC) to a higher, more youthful position. The technique chosen determines where scars are placed, how much tissue can safely be removed, and how well nipple sensation and blood supply are preserved.
Dr. Rafizadeh selects among several established techniques based on your breast size, degree of ptosis (droop), skin quality, and the amount of tissue to be removed. Understanding the differences helps you know what to expect from your surgery and recovery.
The Two Decisions: Pedicle Type & Incision Pattern
Every breast reduction involves two separate but related decisions:
1. Pedicle type — the method by which the nipple-areola complex maintains its blood supply and nerve connections during surgery. The pedicle is a "bridge" of tissue that stays attached to the nipple even as surrounding tissue is removed.
2. Incision pattern — the shape of the skin excision that determines where scars will be visible on the breast surface.
These two decisions are somewhat independent — an inferior pedicle, for example, can be used with either a lollipop or an anchor incision. The best combination is chosen based on your specific anatomy.
Pedicle Types — Comparison
| Pedicle Type | How It Works | Best For | Sensation Preservation |
|---|---|---|---|
| Inferior Pedicle | Nipple supplied from below; tissue bridge runs toward the lower breast fold | Most common; moderate to large reductions; reliable blood supply | Good — lateral cutaneous nerve preserved in most cases |
| Superior / Superomedial Pedicle | Nipple supplied from above and medially; shorter travel distance | Smaller reductions; better upper pole fullness; Hall-Findlay technique | Excellent — preserves the dominant nerve branch in most patients |
| Central Mound (Vertical) | Nipple attached to a central column of tissue with superior blood supply | Moderate reductions with vertical scar technique; good long-term shape | Very good; central nerve preservation |
| Free Nipple Graft | Nipple removed entirely, replaced as a skin graft after reduction | Very large reductions (gigantomastia); nipple must travel too far for a pedicle | Partial to none — nerve continuity is severed; sensation may partially return |
Incision Patterns — In Detail
Anchor Incision (Wise Pattern / Inverted-T)
The most widely used technique for moderate to large breast reduction
Advantages
- Allows maximum tissue removal — suitable for all breast sizes
- Precise skin excision and reshaping of the breast cone
- Long-established technique with predictable results
- Ideal for very large reductions and significant ptosis
- Works well with inferior pedicle for reliable blood supply
Trade-offs
- Three scar segments: around areola, vertical, and horizontal along the fold
- Horizontal inframammary scar is the longest scar in breast reduction
- Scar in breast fold may be visible in some bras/swimwear
- Longer operative time than lollipop technique
Vertical Incision (Lollipop / Short Scar)
Eliminates the horizontal inframammary scar — ideal for smaller reductions
Advantages
- No horizontal scar along the breast fold
- Total scar is shorter than anchor technique
- Often produces rounder, more projected breast shape
- Lower risk of "bottoming out" over time when skin quality is good
- Superior or central pedicle preserves excellent nipple sensation
Trade-offs
- Tissue removal is more limited — not suitable for very large reductions
- Vertical scar may have temporary skin "puckering" at the base post-op
- Requires careful skin management to avoid redundancy at the fold
- Not ideal for patients with very loose, lax skin or gigantomastia
Periareolar Reduction (Benelli / Donut)
Scar hidden entirely around the areola edge — limited tissue removal
Advantages
- Single circular scar at the areolar border — highly concealable
- Minimal visible scarring on the breast surface
- Can reduce areola size simultaneously
- Suitable for minor reduction combined with lift
Trade-offs
- Very limited tissue removal — typically less than 200–300g per side
- Areolar scar can widen (spread) over time if not supported by purse-string suture
- May flatten breast projection if used for reductions it's not designed for
- Not appropriate as a standalone technique for macromastia
"The right technique is the one that safely removes the right amount of tissue for your anatomy — not the one with the fewest scars at the expense of an inferior result."
— Dr. Farhad Rafizadeh MD FACS
Scar Location at a Glance
Periareolar Only
One circular scar around the areola edge only. Hidden at the color-change border.
Lollipop (Vertical)
Periareolar ring + vertical line from areola base to the breast fold.
Anchor (Inverted-T)
Periareolar + vertical + horizontal scar along the inframammary fold.
All scars — regardless of technique — fade significantly over 12–18 months. By 2 years, most patients find their scars light, flat, and easy to conceal in ordinary clothing and swimwear.
Wondering which technique fits your anatomy? Dr. Rafizadeh sees patients from across NJ and the NYC metro.
Which Technique Is Right for You?
Dr. Rafizadeh makes this determination at your consultation based on measurements, breast tissue composition, and the volume to be removed. The following general guidelines illustrate how the decision is made:
Moderate to Large Reductions
Best when removing more than 400–500g per side, significant ptosis is present, or skin is loose and lax. Provides maximum reshaping capability and the most reliable long-term result.
Smaller Reductions with Good Skin
Best when removing 200–500g per side, skin elasticity is good, and ptosis is moderate. Avoids the horizontal scar while still meaningfully reducing size. The Hall-Findlay technique is a popular variation.
Minor Reduction / Areola Resizing
Best reserved for patients needing only modest reduction (<200g per side) combined with mild lift. Often combined with breast lift rather than used as the primary reduction approach.
Recovery: What to Expect by Technique
Recovery from breast reduction is generally similar across techniques: most patients return to desk work in 1–2 weeks and to light activity in 2–4 weeks. For a fuller walkthrough, see our guide to breast reduction techniques. The technique does influence certain aspects of recovery:
- Anchor incision: The horizontal scar runs in the breast fold and requires meticulous wound care. Showers are typically permitted at 48–72 hours; no baths or submersion until 4–6 weeks.
- Vertical/lollipop: The vertical scar often has temporary "gathering" or skin puckering at the base in the first 6–8 weeks — this resolves as tissue redistributes and is not a complication.
- All techniques: A supportive surgical bra is worn for 4–6 weeks. Underwire bras are avoided for at least 6 weeks. Final breast shape and scar maturation are assessed at the 6-month and 12-month mark.
Dr. Rafizadeh performs breast reduction surgery at his practice in Morristown, NJ, drawing patients from across Morris County, Essex County, Bergen County, and Union County. Women from Parsippany, Short Hills, Summit, Chatham, Livingston, Madison, Montclair, and throughout North Jersey seek him out for his conservative approach to incision placement and his emphasis on preserving natural breast shape. Patients from New York City also travel to his Morristown office for board-certified breast reduction care.