Surgical technique

Vertical, periareolar or anchor mastopexy: which one to choose

Three types of mastopexy, three scar patterns, three different indications. The technique is not chosen by preference: it is chosen based on the grade of ptosis, the amount of excess skin and the desired shape outcome. Here is the decision-making.

30 April 2026 7 min read Reviewed by Dr. Claudia Liuzza
Mastopexy: types according to ptosis — Dr. Claudia Liuzza

The key takeaway

The mastopexy technique is not a matter of preference. It is chosen based on the grade of ptosis (breast descent): mild ptosis = periareolar, moderate ptosis = vertical (lollipop), severe ptosis = anchor (inverted T). The greater the descent, the more scar is needed.

  • Periareolar: only patients with mild descent.
  • Vertical: the most used option in moderate ptosis.
  • Anchor: necessary when there is a lot of excess skin.
Ptosis grades Periareolar Vertical Anchor How to decide FAQ

Before the technique: the grade of ptosis

Breast ptosis is the descent of the breast. It is classified into grades (Regnault) according to nipple position relative to the inframammary fold:

  • Pseudoptosis: nipple above the fold but breast empty in the upper pole.
  • Grade I (mild): nipple at fold level.
  • Grade II (moderate): nipple below the fold but above the lower breast pole.
  • Grade III (severe): nipple at the lowest point of the breast, pointing downward.

The grade defines the technique. Not the other way around.

Periareolar mastopexy (round scar)

The scar remains only around the areola. It is the mastopexy with the least visible scar.

  • Indication: mild ptosis (Grade I) or pseudoptosis.
  • Scar: circular, periareolar, usually integrates very well.
  • Limitation: maximum nipple elevation ~2 cm. If more is needed, this is not the right technique.
  • Specific risk: breast flattening and areolar widening over time if the indication is forced.

Vertical mastopexy (lollipop)

Periareolar + vertical scar going down from the areola to the fold. It is the most used technique in moderate ptosis.

  • Indication: Grade II ptosis.
  • Scar: lollipop-shaped. Discrete once mature.
  • Advantage: allows good shape remodelling and nipple elevation without horizontal scar.
  • Limitation: the excess skin in the lower pole is redistributed, there may be small initial pleating.

Anchor (inverted T) mastopexy

Periareolar + vertical + horizontal scar at the fold. It is the technique with the most scar but the only option when there is a lot of excess skin.

  • Indication: Grade III ptosis, or large breast reductions.
  • Scar: anchor or inverted T shaped.
  • Advantage: total control of excess skin, very stable shape outcome.
  • Limitation: extensive horizontal scar that in some skin types may be visible.
Grade IPeriareolar
Grade IIVertical (lollipop)
Grade IIIAnchor (inverted T)

How the decision is made in consultation

In consultation we assess:

  1. Grade of ptosis with real measurement (not by eye).
  2. Amount of excess skin.
  3. Current breast volume and whether or not you need an associated implant.
  4. Skin quality and history of scarring.
  5. Your goal: prioritise minimum scar or maximum shape stability?

When a smaller technique would leave you "fine at one year but bad at five", we say so. Forcing a periareolar in a Grade II is the most frequent cause of patients returning 18 months later with a recurrent ptosis.

Frequently asked questions

Can I choose the technique with the smallest scar?
Only if your ptosis grade allows it. Forcing the indication to a smaller technique ends in a result that drops within a few years.
Are scars noticeable afterwards?
They mature over 12–18 months. The periareolar usually camouflages very well. The vertical fades fine over time. The horizontal scar of the anchor is the most variable depending on skin type.
Can I combine mastopexy with implants?
Yes. Very common. The implant adds upper pole volume and the mastopexy lifts. Read our article mastopexy with or without implants.
Can I breastfeed after mastopexy?
Usually yes, especially if the pedicle is preserved. Assessed case by case.

Want to know which technique fits your case? Book your free consultation. More about mastopexy here.