I had a breast augmentation five years ago and now want a revision to achieve smaller breasts and to get rid of the "rock in sock" appearance. My current incision is under the breast crease, but I also want my areolas reduced. So would a plastic surgeon go through my old incision site or around the areola for the revision?
Where Should Breast Augmentation Revision Incision Be?
Doctor Answers (5)
Breast augmentation revision, areolar reduction and possible lift
If one of your goals involves reduction of the size of the areola then you will need an incision around the areola. Depending on the extent of extra skin you may also need some type of lift. In general, it may be possible to remove your current implants thru an incision in the lower portion of the areola and replace with smaller ones. If the nipple areola position doesn't need to be lifted much and there is a minimum of extra skin then the areolar reduction and a mini lift (circum-areolar lift) may be accomplished leaving a scar around the circumference of the areola.
If there is more skin or more movement of the nipple required then a circum-vertical mastopexy may be done. This leaves a scar around the areola and a vertical scar--sometimes called a tennis racket or lollipop scar.
The next option, sometimes called a full mastopexy, inverted T, or Wise pattern involves the previously described scars plus some length of scar horizontally near the fold below the breast.
in general the greater the discrepancy between the contents(the breast tissue and implant volume) and the degree of extra skin, the more scar necessary to achieve a pleasing shape.
Breast incision locations
Based on your description and your desire to have smaller breasts, in addition to reducing the areola, you will likely need some form of breast lift to achieve your goals. A consultation with a board certified plastic surgeon will help to answer your questions more accurately. A breast lift involves several different types of incisions but all involve an incision around the areaola. The additional incisions may be vertically oriented below the areola and horizontally within the crease under the breast. The best procedure will be determined by the consulting surgeon based on the amount of excess skin, the size of the breast desired, the "look" desired, and the experience of the surgeon.
Dr. Sean Simon
Breast implant revision incision
Since you have stretched-out skin with a "rock in a sock" appearance, large areolar size and a pre-existing infra-mammary incision, there are a number of options that couldbe used to replace your implants. For the areolar reduction, you will need (at minimum) a circular incision around the areolar area...and the breast implant replacement could be done this way. If you have enough loose skin to require a vertical or inverted T incision, then the implant could also be changed with those approaches too.
Your surgeon can advise you, after a proper consultation, about the best options for you. But they could all work.
Best of luck,
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Breast revision incisions for remove replace revise "rock in sock" deformity
In order to reduce the size of the areola a circumareolar incision is required at the very minimum. However, if true sagging is present this may need to be extended into a vertical or so called "lollipop or tennis racket" type incision which would probably connect wtih the existing crease incision
Breast implant revision
If you already have breast implants placed through an inframammary incision (breast crease) but desire the implants and the areolas to be downsized, I would recommend an incision at the lower border of your areola (periareolar). This will allow access to decrease the size of your areolas with a circular incision and also allow better exposure of your breast pocket, in the event you have some hard scar tissue (capsules) that needs removal.
Please be examined by a board certified plastic surgeon prior to your planned areolar reduction and implant exchange.
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.