In my reading the Q/A in realself, I came across a PS that said African americans should NEVER use an areola incision beacuse of scarring. this has really bothered me because i was finally happy that I didnt have to have the lollipop scar and I thought this scar would be much less noticable. I also have very large areolas and my PS is making them smaller. Please let me know if I will absolutely have terrible scarring or does it vary from cast to case. Also, 400cc too big for Benelli lift?
African American Worried About Benelli Lift Scar, What Can I Expect?
Doctor Answers 15
Breast lift scars in an African-American woman.
Never say NEVER about anything!
I have performed breast lifts on African-American, Hispanic, Asian, and Mediterranean women for 25 years, and the worst scars I have ever seen were on a lily-white Caucasian woman! The risk of hypertrophic or keloidal scars is slightly higher in patients of color, but the vast majority of women of any race undergoing breast lift will have very nice scars after they heal and mature fully. Just look at the photos in my breast lift spotlight, on my RealSelf photo page, or on the link below for one of my patients with dark skin and good scars (full breast lift).
However, you could have the genetics that might lead to thicker, wider, or worse-appearing scars, particularly if you have these elsewhere on your body.
The reality is that often patients are seduced by the supposed simplicity and "less-scarring" design of the periareolar-only Benelli scar, which is suitable only for patients who need a minimal lift. If a more substantial lift is needed, trying to make a much-larger circumference purse-string to a much-smaller areolar diameter causes far too severe mismatch, causing pleats in the skin as the outer large-circumference cut is "gathered" to the smaller-circumference desired areola size, and creating MORE irregularity in the precision of the suture closure. This lack of skin-skin accuracy is actually a stronger cause of inflammation and irritation which stimulates bad scarring--the very thing you are trying to avoid!
I agree with Dr. Rand that sometimes those who try for Benelli lifts when a full lift would actually be more precise, accurate and with better skin tailoring end up with the problem scarring they sought to prevent!
As far as size, 400cc may be too big if your skin brassiere after lift is too tight. The fact that your surgeon is considering a Benelli "lift" suggests that perhaps a lift is not needed at all, although your areolas would still be very large. Perhaps other opinions with ABPS-certified plastic surgeons may help to clear up your questions and concerns. Best wishes!
How Bad Will I Scar?
African Americans or anyone with darker skin color are at a higher risk for developing hypertrophic (excess scar) or even keloid (severe overgrowth of scar) scar formation. Higher risk does not mean "for certain". Many things determine your risk including a personal or family history of poor scar formation. We have performed hundreds of surgeries on many different skin colors and types and have found that many end up with beautiful scars. Without seeing photos it is hard to give you specific advice. If your areolas are very large, then a Benelli lift may not be appropriate because of the high risk of scar widening or stretching. If you are not certain or comfortable with the choice your surgeon gave you, then seek a second or even a third opinion.
Breast lift scars for a dark skin tone
There are risks for hypertrophic scars and hyperpigmentation with a breast lift, and they can actually occur in all skin types, though as an African American we can understand your worry. The risk is not greater or less than with breast reduction, and we have a fairly broad experience which indicates the risk is present, though not for all, even with a darker skin tone. If the areola is very large, relapse or sretch is reduced with the vertical pattern. Look at many postings and photos of individuals like you to get an idea of how things have worked out for others.
Best of luck, peterejohnsonmd.com
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African Americans should be wary of Benelli (periareolar) breast lift.
The best scars result when the incisions are closed with tension. A periareolar lift always is closed with tension. That's why I think it is seldom a good procedure in any patient but particularly African Americans.
If you have very large areolas you will need circumareolar incisions to reduce their size. However, if you have a significant amount of ptosis, this approach may not be enough. You will be better served if you would consider re-submitting this question with pictures. Techniques vary depending on what we have to work with and your desired outcome. I have personally operated on a high percentage of AA women with almost invisible scars around the areolas. It's all about technique and surgical skill of your PS.
Best of Luck,
Gary Horndeski, M.D.
African American and Binelli Lift Scar
You have very good reason to be concerned, but not necessarily because you are African American. While its true that some people of color tend to make thicker or keloid like scars, this is actually quite unusual on the breast unless there is some problem with wound healing. I do lifts and reductions on African Americans all the time and they get very satisfactory results.
It is a misconception to think that a Binelli Lift always results in a lesser scar. As Dr. Rand pointed out, the very worst scars from Binelli Lifts are a result of trying to avoid the scars of a more complete lift is needed (which can turn out quite good), and trying to accomplish too much with a Binelli lift which results in excessive tension on the wound leading to widening, pigmentation irregularities, and generally poor scarring. With a very large areola you are at even more risk for problems. Adding an implant tends to put even more tension on the scar. Also Binellin lifts tend to flatten the breast, so if your breast is already flat, the Binelli lift would not be a good choice.
Although you might prefer to avoid the scars of a lollipop or traditional lift, those might ultimately be a better choice for your situation.
I hate blanket statements like the one you described. I have used circumaroela incision in patients of all different ethnicities. Most do extremely well. Sure like any incision there could be problems in some individuals but the majority do very well.
Breast Lift Scarring for African American Women
Women of African heritage in the United States often have a lot of racial mix. No rule holds across the board. Paler skin types tend to make less noticeable scars than darker skin types. My African American patients usually make good scars if they have no personal or family history of hyperpigmentation (scar darkening) or keloid formation (overgrowth of scars). Less scarring can be beneficial for the person at risk for unsatisfactory scars. The choice of implant size and pattern of breast lift incisions is a judgement call that can only be made in person. The implant and skin envelope need to match. Too tight a skin envelope can create tension that results in bad scars for any skin type. Too large a skin envelope leaves droopy skin. Implants and lifts done together have a high revision rate, approximately 20%, because it is difficult to get it exactly right even by the most experienced plastic surgeons.
Benelli in african american skin
Without pictures or seeing you in person, it is impossible to give you specific advice. However, most people who are looking for a Benelli lift really should consider a traditional life. The Benelli lift places a lot of tension not he incision which can make the scar wide. Additionally, without the vertical component to the lift, there is less control over the shape of the breast. So, those patients that demand a smaller incision are really doing themselves a disservice by limiting the full potential of what can be achieve with surgery and often end up with a smaller but less aesthetically pleasing incision.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.