Considering A Lift With 550cc Implant, How Do I Know What Is The Best Size For The Areola?
Doctor Answers (9)
Areola size in a lift/augmentation
In general this question has been well addressed. I would make a few other points. Average areola diameter is about 4 1/2 cm in a breast that is not too big or too small. A breast augmentation alone will not change the size of the areola if it is not collapsed, but since you need a mastopexy, the areolar diameter can be set. The trick is to control the size of the areola which is a bit like trying to control the exact width or appearance of a scar. An augmentation with the pressure of the implant from behind will tend to stretch the areola in unpredictable ways. A permanent pursestring suture of Gortex is one way to try to control this but has other potential problems. The surest way to control all the factors is to do the lift first and then plan the augmentation later after healing and settling. I would also counsel against using the picture of a clothed celebrity as an example of the expected result or look. Before and after pictures need to be upright, in good light, nothing on, arms down, and with standard angles.
Areola size after breast lift
The ideal areola size is a personal preference that varies among individuals. This is one of the many topics I cover with my patients in preparation for breast lift (or reduction) surgery, where I have lattitude in creating the nipple size. In general, many surgeons will use 42 mm diameters as the optimal areola size for most patients. I find that many of my patients prefer areolas smaller than that, but some do prefer larger. Also, it is natural for the areola size to increase with larger breasts. Following 550 cc implants, most of my patients would probably prefer an areola diameter of approximately 42 mm.
Best Areola Size in Breast Lift/Augmentation
Although areola size varies, most would agree that an ideal areola diameter would be 4-5 cm. (2.5 cm.=1 inch). It is difficult to tell what type of breast lift would be best for you without a physical exam, but you should know that in a peri-areolar lift (scar around the edge of the areola) the areola tends to stretch over time. The most successful way to control the size of the areola is by using a gortex stitch. That's the easy part compared with choosing an implant size. If you have a lot of breast sagging, the breast skin has already lost some of its' elasticity. The larger and heavier an implant you choose, the more likely you will be to have the sagging return. Consider choosing a silicone gel breast implant, which is lighter than the same size saline implant, and consider a somewhat smaller implant if you want results that will last.
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Under 5 cm
Most women consider areolae over 5 cm to be too large. If you are having a lift, the areolar size can be as small as you want. However, the areaola tends to stretch out, particularly in the presence of implants. So if you want an areolar diameter under 5 cm, the width should be set to 3.8 cm. Be sure you are having a vertical lift. Inverted-T causes too much scarring and does not provide a pleasing shape. The periareolar technique stretches the areaola and is ineffective in correcting breast sagging. Look at plenty of before and after photos of your surgeon's work. This operation is done differently by different plastic surgeons and the results are highly variable.
Web reference: http://www.swansoncenter.com
Ideal size of areola
Ideal size of areola is considered to be 4.5-5cm. As you would expect some stretch after areolar reduction, I would consider keeping the areola about 4.5cms in diameter. I would also take into account what you, the patient, want.
Areolar size can be reduced
There is a wide variation of areola sizes that look attractive. Since your are having both an augmentation and a lift done, you can expect to have some dilation of the areolar diameter over time. I usually set my areolar diamters between 42-45 mm and expect some dilation - depending on implant size and tension on the areolar closure.
Web reference: http://www.breastlift-seattle.com
Breast lift and areola size
Areola reductions begin by removing the pigmented area either from the outside of the areola or from around the base of the nipple. Dr. Pousti minimizes the incisions so that there is minimal scarring. Dissolving sutures are used so that suture removal will not be necessary after the procedure. Clear communication with your plastic surgeon is important in achieving the desired goals of the patient. I like to communicate with patients with “goal” pictures. During surgery, I use temporary sizers to determine the size/profile that will give the patient the look she is looking for. Trying to predict the size of the implant preoperatively is not ideal. I think it is too much responsibility for the patient to choose the size of the implant. Ideally, the surgeon would make that determination once he/she is in the operating room with sizers in and examining the patient in the upright and supine position. There are many variables that come into play when choosing the correct implant size (how much breast tissue the patient currently has, the shape of the chest wall (concave vs. convex), etc..
On this site, I do my best to give advice without a physical examination but I want you to know that a physical examination by a board certified physician is always the best way to get the most accurate information.
What areolar size would be best?
You have good sized breasts, and usually we set the areola at about 42 mm and expect some not completely predictable areolar stretching over time. Please be aware that a full lift, which you need, and an implant augmentation, particularly with large implants such as 550cc, are very difficult to do together. There is a significant risk of healing issues as you tighten a large sagging breast with a fair weight of breast tissue around a large high profile saline implant, as well as contour problems as you try to balance these two opposing and sometimes antagonistic procedures...expanding procedure of augmentation (with a LARGE implant) and a tightening procedure of a lift. Be warned, and be aware of the possible problems even in experienced hands. Browse through some of the photos and questions from patients on this site if you need to see examples of some issues that can arise.
Adding that large implant to the lift will make "setting" the areolar diameter very, very tricky. The implant will put pressure on the closure and could cause the areola to stretch. Augmentation at the same time as lift is very, very tricky and the re operation rate is high.
If you were my patient (in Seattle where we like it look like it could have, on a good day, occurred in nature) and were not impressed with Heff's lady friend (who I think is now an ex-friend), I would implore you to just have a vertical lift. Your breasts are plenty big in my opinion. A vertical lift would make your breasts look a little bigger, give you some nice upper pole fullness and would leave you 100% you with no implant to maintain over your lifetime. Also, your areolar diameter would be a lot easier to "set".
Web reference: http://www.sowdermd.com/blog/my-favorite-procedure/
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.
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