Areola Reduction with No Skin Excision--periareolar Subcuticular Purse String Suture? (photo)

Feeling self concious about areola size after 300cc impants and then having a child. I would like to exchnage impants for 425-475cc moderate profile, but my Dr. doe not recommend a lift because the scarring is not worth the trade off in his expert opinion (and he feels I dont need a lift). Anyone have experience with periareolar subcuticular purse string suture to reduce areola size less dramatically than with skin excision? Your opinion is very appreciated.

Doctor Answers 13

Scarring is a trade-off.

Your picture suggest slight enlargement of your areolas in the absence of significant breast sag.Unfortunately, your arms are elevated in this picture which may cause the extent of your breast sag to be underestimated.For this reason, a physical examination would be helpful.
In general terms, periareolar mastopexies usually require a skin resection.When a purse string is performed around the areola without an adjacent tissue resection, the areola tends to be puffy and protuberant. It doesn’t lie flat if there’s not an associated partial areola resection.
Furthermore, scarring is variable with periareolar mastopexies.Scarring occurs when wounds are closed under tension. This is more likely when the procedure is used to provide lifting of the breasts and discrepancies exist between the length of the opposing wound margins.
For these reasons, it’s important to realize that areolar reduction and periareolar mastopexy may involve significant tradeoffs.In some cases, the scarring associated with this procedure may be worse than the slightly enlarged areolas that concern you.
Under these circumstances, it’s appropriate to proceed with caution.Make sure you consult a board certified plastic surgeon and get all your questions answered. Remember that once you have scarring in this location it can be hard to treat.

Areolar Reduction Breast Surgery

Patients often ask me if their areolas will appear larger after breast augmentation.The areola will measure larger but the proportion of your areola to breast will not change. Based on your photos, I agree with your surgeon that you do not appear to need a breast lift.  The areola can be made smaller by excising a portion of it or by placing a purse string suture.  In my experience, doing both gives the most long lasting result.  Remember, by increasing the size of your implant from 300cc to 425-475cc will also make your areola appear larger.

Areola reductions bring the potential for scarring

and I personally agree with your surgeon that you should not do anything.  This is not a perfect world and your areolas are more generous than you desire.  But would you like it better if you had a smaller areola with a horrendous scar around them?   My patients would not like that. 

If you do see other doctors and they promise they can achieve what you desire, I caution you and ask that you understand their revision policy should things not work out as you desire so you are not left 'holding the bag' in the end and worse off then what you started with.

Curtis Wong, MD
Redding Plastic Surgeon
5.0 out of 5 stars 23 reviews

Large areolas

Yes you could have a donut mastopexy/arealor reduction but since want to go bigger it may limit the size of your new implants but a periareolar reduction wiuth a purstring is fine.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 44 reviews

Periareolar reduction

I personally believe that you would benefit with an areolar reduction, regardless if you change your implant size or not.  I am not a big fan of the purse string.

Talmage Raine MD FACS

Talmage J. Raine, MD, FACS
Champaign Plastic Surgeon
4.5 out of 5 stars 8 reviews

Areola Reduction with No Skin Excision

Areolar reduction is almost always done with skin excision as the standard. The scars are usually an acceptable trade off for the improvement. I would ask your surgeon to show you some photos of average scars after a per--areolar lift so that you can get an idea of what to expect, though scars are different on each patient. Then you can make a reasonably educated choice as to whether the scar is worth it for the expected size reduction. 

Sometimes it is possible to make a number of stab incisions around the areola to place the permanent purse-string suture, but you would need quite a few of these, and I am not sure that the smaller intermittent scars would be better than the standard incisions.

Thanks for the question, and best wishes.

Circumareola sutures

I perform circumareola suture placement for the situation you describe and for small areola lifts all the time. you should go for a consultation.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

Areola Reduction with No Skin Excision--periareolar Subcuticular Purse String Suture?

By the definition of the purse string operation we are removing areolar skin! So a scar could occur. Best you seek in person evaluations to fully understand this technique. 

Areola Reduction with No Skin Excision--periareolar Subcuticular Purse String Suture?

Areolar sub-cuticular sutures can be use in selected cases but are not very effective 

You could reduce the size of your areolae without a lift or even excising skin. but it will involve a scar around the areolae

These scars usually heal very well

Hilton Becker, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 9 reviews

Misunderstanding areolar reduction

An areolar reduction with permanent suture control of the areolar size would probably be nice but it dies involve excising some skin.  It isn't done by just putting in a suture.

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.