I'm looking to get a full tummy tuck and breast augmentation. I'd really like to avoid a full mastectomy or or having a lollipop incision due to the scars. My question is, can I achieve a full/perky look by doing a periareolar lift then filling out the rest of my breast by getting an implant? If so, Exactly what kind of implant would you recommend and how big do you think I'd need to go to acheive the perky look? Also, as you can see my areolas are HUGE. I will be looking to reduce them as well.
Will a Periareolar Lift Plus Implants Give a Perky Look?
Doctor Answers (30)
Periareolar vs Lollipop Breast Lift for Perky Breasts
Without an exam and learning from you more information about your wishes it is hard to give you a definitive answer. The answer to your question lies in letting you surgeon know specifically what you would like to look like following the surgery. For example, how perky do you want to be, what shape do you want to have, etc.? However from the one photo you provided it would appear that a lollipop type lift would be best for you. periareolar lift. Here is a rule of thumb that works for most patients. If you nipple is above your lower breast crease then often a periareolar lift will be sufficient for most patients. If your nipple is at or below your crease then a vertical lift (lollipop lift), inverted T or anchor pattern may be required.
Types of incisions for mastopexy surgery
Based on the photo and information you provided, you would benefit significantly from a tummy tuck and breast lift with augmentation surgery. To answer your question, a periareolar incision alone may not provide the perky look you would like to achieve. Due to the amount of tissue you need tightened and removed, it may be more beneficial for you to have the "lollipop" incision which includes the vertical scar. Yes, the downside is the scar, however, the results will be longer lasting. I recommend consulting a board certified plastic surgeon to discuss the best and safest options for you. In some cases, it may be necessary for these procedure to be done in 2 stages for safety reasons. For instance, your surgeon may do the lift and tummy tuck first, and then after recovery which may be 3 months or longer, do the breast augementation. There are a variety of options to choose from depending on the severity and complexity of the case. Good luck!
I perfrom periareolar lifts with implants all the time. It is a great operation in the properly chosen patient. You may very well be a candidate but it is hard to tell without an exam.
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Periareolar mastopexy is recommended in our Practice
I would add the view of polite dissent to the discussion. I have been performing periareolar mastopexy in cases of increasing difficulty for many years wherein the nipple may be reduced and lifted significantly. In patients of color it is particularly well suited since there is but a circular skin repair, which in our series of 217 cases resulted in only a 4% scar revision rate.
While the areola may dilate, it is rare to assume the preoperative size. I would recommend the periareolar mastopexy in your case as my personal and individual preference. See Application of the Goes Double-Skin Mastopexy with and without Implants featured on line as of January 2010. The abstract interestingly enough shows photos of comparable cases like yours without having to purchase the article at present. For the full article you would need to register with the Journal of Plastic Reconstructive and Aesthetic Surgery.
Thanks for your question and to the respondents who have provided an educated and personal view of the operation in their experiences. Addional photos can be seen on my website.
Periareolar mastopexy will flatten the breast when combined with breast implants
Great question and the photo helps. I would caution against the periareolar mastopexy in your case as you do need a significant lift which a periareolar lift will not be able to accomplish, as well it places too much tension on the areola which can widen over time leaving you with even wider areola. As well the periareolar approach has a tendency to flatten the appearance of the breast. All combined, this plan will not achieve the result you are looking for.
I would recommend at least a vertical if not a vertical and horizantal skin excision with a possible conservative or staged implant.
I hope this helps.
What breast lifts and implants do and don't do
In deciding elective, cosmetic procedures it is important to understand what the procedures do or don't do based on real experience rather than hype and wishful thinking.
Neither a lift (mastopexy) or breast implants give true perkiness in the sense of youthful tone and breast characteristics. Breast implants give the illusion of perkiness because they fill out the upper breast concavity and give projection to the center of the breast but the minimum size increase from the volume of an implant (properly fitted) is one cup size. "Periareolar" or "crescent" lifts do not give any perkiness and in reality do little to reposition a breast that is too low. At best they move the nipple-areola up slightly at the expense of generally poor scars. Even a full mastopexy, which today can be done with a "vertical" approach and "lollipop" incision, doesn't do much more than reposition the breast and reduce areolar size. Neither lifts or implants actually "tighten" or increase tissue tone of the breast.
The photo documents a breast position that is too low for breast implants alone and will benefit very little from a periareolar approach. The breast size is adequate and a full lift will make the breast look bigger. A properly sized implant in addition to a lift will make the breast quite large which generally isn't consistent with "perkiness".
I would recommend a mastopexy with a vertical (lollipop) incision without implants and then reevaluate for the need for implants later on. "Perkiness" in this situation is not a reasonable expectation. A breast that is properly positioned and shaped will look better and the volume there will look better without the need for a bra to hold it up. The trade-off is the scars involved.
Periareolar lift with implants can give a perky look, but is not right operation for everyone
From your photo, you definitely need a lift. Traditional plastic surgical thinking would hold that you need more skin excised than can be done with only a periareolar lift. It some cases, reshaping of the breast tissue can make it easier to take out less skin and still have a lasting breast lift.
Another important question though is whether you want your breasts to be larger than they are now, or just perkier. Implants will make your breasts bigger so if you are happy with the size, a lift may be all you need.
May need more lift
Breast augmentation and lift can be performed. If you had a periareolar lift it would reduce the size of the areola but how perky they will be depends on what you are looking for. The "lollipop" incision is very powerful portion of a lift. This incision aids in the projection of the breasts (perkiness). I think if you had only the periareolar lift with implants you will have to accept a more mature look to the breasts.
Visit with a couple of plastic surgeons to get a complete exam and recommendations.
Periareolar "lift" - limited utility
After seeing your breasts, I strongly discourage you from considering the periareolar lift. In my opinion, the periareolar mastopexy is an operation that has very limited application. It is useful for reducing areola size and for slightly moving the areola position. It tends to flatten the breast rather than lifting it, and can result in very abnormal appearing areolas. Think about this: areola skin is thin and soft, similar to eyelid skin. Breast skin is thicker, similar to cheek skin. The periareolar mastopexy is performed by removing a dough-nut of skin from around the areola, and "purse-stringing" the breast skin in towards the nipple. Even if a reinforcing permanent stitch is used to hold the thick breast skin inward, often the breast skin "wins" and stretches the areola out to strange proportions. (This is much more likely to happen if you add the stress of an implant behind it!)
To get the best result, you should stage your operations - perform a lift first and let the scars heal without the tension caused by an implant (this will give you the best looking scars). Once they have healed (3-6 months), you can safely place a proportionately large implant and achieve the perky look you are searching for.
Periariolar Breast Lift and Breast Implants
An augmentation mastopexy is one of the most common breast procedures that plastic surgeons do. The breast sagging or ptosis and the loss of volume, especially upper pole fullness, makes this a necessary combination.
The periareolar or donut mastopexy is great to reduce extra skin and lift the nipple. However, the nipple can really only be lifted, at most, 5cm or around 2 inches. This can be less depending on the implants. Larger implants can, by themselves, lift the breasts 1-2cm.
So looking at your pictures I'd say it's going to be close whether it can be done well with just the donut or if you'll need a vertical incision as well to get a home run result. Only a face-to-face consult will reveal this.