Until There is Shrink-Wrap Skin and a Magic Wand vs. a Scalpel, There Will Be Scars

Without question, the single aspect most feared by most women when it comes to Breast Lift or Breast Reduction is the necessary scars.

Both Breast Lift and Breast Reduction involve creation of a pattern of skin removal in order to decrease the skin envelope, whether or not the breast itself is reduced in volume.  This is quite similar to dress-making or tailoring, wherein a beautiful dress that your mother once wore needs to be taken in a bit so that you or your daughter can wear it.  There is an excess of "material" or skin in this case that needs to be reduced so that the proportions are appropriate.

In a similar fashion to tailoring, we plastic surgeons attempt to hide the scars within "natural" skin folds or otherwise disguise their presence.  In the case of the breast lift or reduction scars, there is almost always a scar around the areola, and a scar of variable length extending down to and along the fold beneath the breast.

A well-healed scar around the areola is almost indistinguishable, as it is hidden to our eye by the "normal" expected color difference between the darker areola pigment and the lighter breast skin around it, even on close inspection.  The benefit to this scar is that it would be impossible to reduce the diameter of the areola without it.

The next most-feared scar for a lift or reduction is the vertical scar extending from the bottom of the areola circle down towards the fold beneath the breast.  Ironically, although this is the most "exposed" of the scars, being located on the front of the breast, I find that it usually heals the best, provided that the skin is not closed "too tight" at the time of the operation.  In these cases, the scar may widen and become more noticeable.

Often, the scars must extend into the fold below the breast ("infra-mammary" fold or crease) in order to properly shape the breast skin envelope.  This scar should not be a "deal-breaker", however, as long as the following points are kept in mind: 1) the scar should not extend in the fold beyond the width of the breast itself (i.e., not too far towards the cleavage area or past outside border of the breast), except in cases of very large or very droopy breasts; 2) the fold below the breast is like a natural "seam" where the scar can be hidden; 3) the breast is likely to still be somewhat pendulous even after lift or reduction, and will probably over-hang the scar in the fold to some extent, thereby obscuring it's visibility.

Although wide, hypertrophic (thick), or atrophic (weak and thin) scars do occur on occasion, these can often be improved by topical treatment or surgical revision where necessary.

Finally, my experience has been that every patient who was asked post-operatively whether they prefer the appearance of their lifted or reduced breasts with the scars, or if they regret the scars and would prefer to have the heavy and/or droopy breasts back without the scars, choses the new breasts over the old.  In fact, most patients tell me they wish they had done the operation sooner, and would have done so if not for their (unfounded) fear of the scars.

So, conquer your fear of scars.  They are a necessary evil of the current state of surgical art.  Until there is shrink-wrap skin and a magic wand instead of a scalpel, there will be scars.  It is the job of the plastic surgeon to hide them as the best tailors do when making a beautiful new dress from an old sack.

If we could avoid breast lift scars, we would. When we can reduce their length, we do. But they are there for a reason.

The brief answer to your question is that yes, breast lifts can be done with a scar only around the areola. But depending upon your breast shape and size, that may not give an ideal shape.

The history of breast lift surgery (and breast reduction, too) is really a journey into finding a better pattern of scars for removing the excessive skin, so that there is an optimal shape, a longlasting result, shorter scars, and thinner scars.

As you would imagine, some breasts require more scar to get an ideal shape. And some women put a different value on the trade-offs of scar length and location for breast shape. And surgeons have their own opinions about which looks the best and gives the best result.

The most common procedure is something that involves an "inverted T" or an "anchor" scar,one that goes around the areola, goes straight down, and then underneath. It's a lot of scar. Advocates - and I am one - feel that it gives the best shape, tightens the breast most completely and thoroughly, and because tension is distributed evenly along the length of the scars, that though long, the quality of the scar is likely to be good. Critics think that the benefits of the shape do not justify the length of the scar, and that this technique is prone to something called "bottoming out", which is when the lower part of the breast stretches.

Gaining in popularity is something called the vertical lift, which involves a scar around the areola and then straight down the breast, eliminating the underneath scar. Proponents think that the shape is good, that the breast maintains a lot of projection over time without bottoming out, and that the underneath scar is avoided. I believe that many of these breasts look overly projecting to my taste, and that bottoming out can be minimized with the inverted T style pattern. I also feel that the underneath scar is rarely seen, and that the scars that are seen - around the areola and going straight down, seem relatively more visible with this technique since it requires some bunching up of the skin during closure. Understand that some of the best surgeons in the world argue with one another about this issue at meetings all the time!

Finally, lifts can be done with a scar just around the areola. A frenchman named Louis Benelli popularized this procedure, as did a Brazilian named Goes. But they do extensive work on the inside to shape the breast, something that few american surgeons actually do. In their hands, terrific results can be achieved, but I have seen inconsistent results with this procedure with american surgeons. Allegedly, it is the operation that has the highest incidence of malpractice suits. This is not due to anything inherently wrong with the procedure, but that the procedure is being used in breasts that are probably too droopy, heavy, and loose for this technique. I have achieved excellent results with this, but only on breast that are relatively small and light, and that don't have a lot of droopiness.

While on the subject of minimizing lift scars, many people use breast implants to fill up an empty or slightly droopy breast. Though this is just a semantic way of thinking about it, droopy breasts need to be lifted, and deflated/collapsed breasts may be fixable with an implant. Of course, a woman has to want to have implants and be larger to approach droopiness with an implant. And one of the most common problems I see in women with implants is women who really needed a lift, but instead chose to put in a big implant, making them larger than they wanted to be and stretching and thinning their tissue out more.

What you need to do is to see several well-recommended surgeons, and listen to their advice. Don't just go with the one who promises you great results with less scars; make sure that everything they say makes sense. If one person suggests that they can get a great shape with substantially less scar than everyone else, be a little suspicious. It may be true, but it may not. Try going to surgery.org to find a good plastic surgeon. Good luck.

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The length of the scar with a breast lift can be reduced significantly with a Lejour pattern vertical limb breast lift / mastopexy. I routinely perform these smaller incision type breast lifts in patients that request minimal scarring.

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