Incision & Scarring Guide

Why Does the Type of Incision Matter in Breast Surgery?

Anchor incisions, lollipop incisions and peri-areolar incisions, common in most breast procedures, aren’t the same. The type of incision your surgeon decides to use has consequences for your healing and your final look. You don’t get to select the incision type, but it sets the starting point for your procedure, including:

• Where your doctor can access your breast tissue
• How much removal and reshaping are possible
• The placement of the scars
• How realistic your goals are

The wrong incision type not only affects your resulting scars, but also your final surgical outcome. If your surgeon has insufficient access to the breast tissue, it may mean he can’t remove or reposition it to accomplish your goals. According to the American Society of Plastic Surgeons, the incision placement in breast procedures isn’t random. It comes from your surgeon’s assessment of your anatomy and the degree of correction needed.

At New York Breast Surgery Center, elite plastic surgeons Dr. David Shokrian and Dr. Mohamed Soliman Ahmed Elfar base every incision decision on your specific anatomy and your goals. Your surgical plan is well considered and personalized to your case. Whether you’re getting a reconstructive procedure or an augmentation, the plastic surgeon plans the incisions well before your surgery.

What Is an Anchor Incision?

Dr. Shokrian explains: “The anchor incision is the most expensive of the three incision types. It’s named for its shape: a circular incision around your areola, a vertical line running from the base of the areola down the crease and a horizontal incision along the inframammary fold. I use an anchor incision when the volume of tissue removal and repositioning aren’t possible with a less extensive approach.”

In cases of a significant breast reduction and for a full breast lift, surgeons prefer an anchor incision. This incision leaves three scars:

1. A circular scar along the outer edge of your areola
2. A straight-line scar that runs from the bottom of your areola down to your breast crease
3. A horizontal scar that runs along the inframammary fold

These scars aren’t visible when you’re standing, and they’re usually concealed beneath undergarments. The scars are permanent, but their appearance changes with time. Recovery timelines vary, but in the first few weeks after an anchor incision, you may notice swelling, bruising and discomfort at their highest levels. You must wear surgical dressings and a bra at all times. Physical activity is restricted to slow walks. Depending on the volume of tissue removed, you may need drain management. The next few weeks include:

• Week three through six. Anchor incision patients report that the swelling resolves. They return to work. Follow-up appointments check the incision sites and healing progress.
• Months three through six. You’re cleared for full physical activity, as the scars start to mature. The vertical and inframammary scars flatten, and the peri-areolar scar begins to blend with your areolar border.
• Months six to 18. This is the remodeling phase, where the collagen reorganizes and scars soften. Pigmentation starts to normalize. You should see your final results by the end of this stage.

What Should I Know about a Lollipop Incision?

A lollipop incision is considered a moderate approach. It consists of a circular incision around the border of your areola and a vertical incision that runs straight down from the base of your areola to the breast crease, leaving two scars. The first is around the areola, similar to an anchor scar, and the second is vertically down the bottom of your breast. The scars are permanent, but the way they look changes.

“I use a lollipop incision when it gives me enough leverage and space to work,” says Dr. Shokrian. “I only use the anchor incision when I need to, and a peri-areolar incision is often too narrow to achieve what I need to do. The lollipop is a standard incision for moderate breast lifts, selective breast reductions and the majority of breast lifts with implants. It’s not a compromise, but the best choice for a specific and well-defined range of cases.”

The first two weeks after your surgery are physically restrictive. You may notice severe swelling, bruising and tightness. You have to wear a surgical bra continuously, and your activity is limited to walking only — no heavy lifting or exertion. Keep your lollipop incisions clean and dry. Make sure you follow your post-operative instructions to achieve optimal results. After a few weeks, you see changes, such as:

• By week four, your swelling decreases and your breast shape starts to settle. Many patients return to their desk jobs. Your surgeon conducts regular follow-up appointments to monitor your healing progress.
• By week five, your scar care protocol begins, including silicon sheeting and targeted scar massage, as advised by your surgeon.
• By month two, you can resume light activities. Avoid direct sun exposure to your scar sites, as UV exposure affects your pigmentation. Use strong SPF when outdoors.
• By month six, most patients are cleared to resume their regular physical activity. The vertical scar continues to flatten and lighten.
• Between six and 18 months, you enter the remodeling phase. Your collagen is reorganizing, scar lines are softening and pigmentation is getting back to normal. Your scars fully mature by the end of this period.

Why Is a Peri-Areolar Incision Considered the Most Minimal?

“A peri-areolar incision, also referred to as a donut incision,” explains Dr. Shokrian, “is the smallest of all three incisions. It produces a single, circular scar. A peri-areolar incision involves a circular incision made along the outer edge of your areola. The pigmentation transition is not incidental. It’s why this incision is the most concealable of the three types.”

A peri-areolar incision is the least extensive incision in breast surgery, but it also provides the smallest access point. This isn’t a disadvantage, but a clinical distinction. When the degree of correction is limited enough to be accessed through a single, circular point, your surgeon chooses a peri-areolar incision. Surgeons use this for minor breast lifts, selective augmentation procedures, areola reductions, inverted nipple corrections and tuberous breast corrections.

Right after your procedure, the scar is visible as a pink, raised, firm scar along the areolar edge. By the third to sixth month, the scar begins to flatten and gradually fades. After one year, most patients report that they only notice a fine line that blends in with the areolar border. While it’s permanent, the scar becomes even more minimal over time. Some dos and don’ts in your recovery period include:

• No heavy lifting
• No overhead movements
• No strenuous activities
• No exposure to sunlight
• Use SPF when outside
• Use a surgical bra until cleared

What’s the Healing Process for Each Incision Scar?

Every surgical scar goes through the same biological stages of healing, regardless of the incision type. The timeline is predictable, but the outcome is not. Your NYC surgeon reviews scar healing at every pre-op consultation. The three stages of healing include:

1. The inflammatory phase happens right after your procedure, when your body initiates an inflammatory response at the incision sites. The area is swollen, tender and red. The scar looks worse at this stage. Don’t panic, this is expected and temporary.
2. The proliferative phase is when collagen production begins and the scar thickens. The color turns deep and appears more prominent at weeks six to eight than it did at week two. Your body at this stage is rebuilding tissue. Scar care protocol has the most clinical impact here.
3. The remodeling phase occurs when the collagen fibers reorganize from a dense matrix into a flatter and more structured alignment. The scar softens and fades. Pigmentation normalizes. Most scars reach their final appearance at this stage, around the 12th to 18th month.

Dr. Shokrian: “Once I close the incisions and you begin your recovery, I make sure you receive a structured scar management protocol. These instructions include how and when to apply a silicon sheeting to promote stability and healing. To break down a buildup of collagen, you use a scar massage technique that reduces the scar’s texture. I adjust this protocol specifically for you, based on your healing process. Your skin tone, genetics, age and post-operative care affect your final results.”

Why Choose New York Breast Surgery Center for the Right Incision Selection?

Dr. Elfar is a board-certified plastic surgeon with extensive experience in complex cases of breast procedures. His experience includes revision surgeries, breast reconstructions and many other procedures that require precision incision planning. Dr. Shokrian specializes in aesthetic planning, with a breadth of experience in primary and revisional procedures. Both understand that incision selection directly influences your long-term outcomes.

Combined, our surgeons bring unique, precise clinical judgment to every incision made at New York Breast Surgery Center. The right incision is neither the smallest nor the largest; it’s the one that best helps you reach your goals. If you’re exploring breast procedures and are confused about anchor, lollipop or peri-areolar incisions, schedule a consultation at New York Breast Surgery Center. Visit either of two NYC locations: Midtown Manhattan or Great Neck, Long Island. If you’re from out-of-town, schedule a virtual consultation.

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