Periareolar Scar and Areoal Very Wide

I had periareolar lift and implants done approx 5 months ago. My areolas are now huge, they are twice the size they were before the procedure. My scar is also red and wide. I have had alot of problems with the sutures. Suture abcessess to be specific. I am still pulling stitches out randomly. My surgeon said when I heal we can do scar revision but this will require vertical scar to keep areola from stretching. How long will this vertical scar be. Is there a different stitch to use.

Doctor Answers (15)

Correcting a periareola breast lift that causes areola to stretch/grow

+2

A periareolar mastopexy is a great operation if kept within the appropriate parameters for its use. That is, to diminish the size of enlarged areola and also to raise the nipple areola a small amount which you can see in first degree ptosis (breast droop). Unfortunately, when you try to get too much out of the procedure, the major complication is nipple areola spread and this is exacerbated in your case by loss of the supporting sutures because of the suture reaction and abscesses’. I agree that in all likelihood you will require some degree of a vertical component in correcting your problem. The length of the scar will be determined by the amount of tissue laxity in the inferior pole and the degree that your surgeon has to diminish the outer circumference. Generally a monofilament “non braided suture” is less reactive. I would also get a second opinion for your own peace of mind. Good luck and please let us know how your revision turns out.


Albany Plastic Surgeon
5.0 out of 5 stars 108 reviews

Breast aug-pexy is a difficult operation!

+1

Recently one of the leading breast surgeons published a letter stating what many of us know, namely breast implants and a lift, concurrently is a difficult operation.  Many women ask about "short scar" mastopexies (breast lifts) and bring in photos of either periareolar (around the areolar) or crescent (above the areolar) lifts, at the same time asking to be "high and tight" D cups.  A PS' responsibility is to explain why superior pole fullness, large volume and minimal scars are virtually impossible to produce and warranty, ad infinitum.  Some women are born with skin laxity, which will not "maintain" the position and shape, i.e the breast mounds eventually slide "down and out", off the rib cage.  While it's tempting to capitulate to the patient's request for short scars, we have the obligation to show them photos of overly large areolar complexes, widened scars, which are well known sequela of this procedure as well as potentially the weight of your implant and the hyper stretchy quality of your skin.

Don't be discouraged about converting to a circumvertical or "lollipop" pattern of scars.  Be patient during your convalescence and work towards improved quality of scars, predictable areolar diameter and less worries.  Good luck 

Lavinia Chong, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 36 reviews

Widened areola and scars after breast surgery

+1

its difficult to say what you may need in terms of revisional surgery without a photo and physical exam.  it sounds like your surgeon is recommending a revisionary plan with a circumvertical mastopexy technique.  I would wait at least 6 months to allow time for healling before proceeding with a revision.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 115 reviews

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Large areola after limited breast lift to be repaired with conversion to vertical lift

+1

It is best for the skin tension to subside prior to scar revision which may take up to 9 months. Oftentimes the areola can be reduced with conversion to a vertical and the length of the scar will depend on the extent of the reduction. This typically extends down to the crease but your surgeon can draw this on your skin so that you will have a better idea.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 43 reviews

Stretched areolas and scars common after peri-areaolar lift and implants

+1

One technique for breast lifting is by making the incision only around the areola. This seems like a great idea becuase the scar is limited to just around the areola.  The problem is that poor scar formation is very common. The scar can be even worse when this incision is used for botha  lift and implants.  I rarely perform this procedure because I find that the risk of poor scar and stetched (wide) areolars is not worth it. Instead, I prefer an incision that resembles a lollipop.  The vertical scar (up and down) on the breast usually heals really well, and patients would rather have this well healed vertical scar instead of a wide areola with thick scar.  The only situations when a peri-areolar list is appropriate is when only the smallest lift is needed. 

Matthew Schulman, MD
New York Plastic Surgeon
5.0 out of 5 stars 160 reviews

Periareolar breast lift and implants - high rate of complications!

+1

I have studied this technique, specifically the Binelli technique of periareolar lift with breast augmentation since my training in residency and there is an EXTREMELY high rate of areolar widening, at least 50%.  I think it is worsened by how big the implant is and how much skin is removed.  There have been a few suture techniques such as those designed by Hammond that can prevent some of this but it is very common.  The infamous Tara Reid case that has surfaced in popular magazines is a similar case.  What we found in our studies was that converting the lift to a vertical (i.e. adding the vertical incision) seemed to "block" the areolar expansion.  Sometimes a smaller implant has to be placed as well to take tension off the incision.  I would recommend waiting some time and allowing it to heal, maybe even up to a year and then seeing an expert with specific training and experience in this procedure as well as revision of this procedure, because it is quite complex.  I hope this helps!

Sincerely,

James F. Boynton, M.D., F.A.C.S.

James F. Boynton, MD
Houston Plastic Surgeon
4.5 out of 5 stars 19 reviews

Breast lifts can be done with or without a vertical scar

+1
Breast lifts are good options for hanging breasts. These can be done within either a periareolar scar or a vertical scar. Each option has it's pros and cons. I am sorry that you are having these issues. The suture issue will end. Some patients do have a tough time with sutures. It's hard to predict. If a braided suture was used before - switching to a monofilament may help

Michael Weinberg, MD
Toronto Plastic Surgeon
4.5 out of 5 stars 23 reviews

What can go wrong with the Benelli breast lift

+1

The around the nipple breast lift has the advantage of precluding a vertical scar, however the procedure is very prone to relapse with a return of the droop, and a dilatation of the nipple areola. The Benelli lift with the 'blocking' suture aimed at reducing the scar and nipple spread is not always effective. Your breast lift has developed all of the problems and the vertical breast lift pattern may save the day. The vertical scar may extend from the nipple to the fold, though it will hold the lift better and prevent the nipple from increasing in size.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 26 reviews

Widened areola

+1

If a permanent suture was not used, or it was lost because of the infection, your areola will widen.  This is one of the most difficult procedures.  Be patient, and it can probably be improved in time.

David A. Lickstein, MD
Miami Plastic Surgeon
5.0 out of 5 stars 3 reviews

Periareola scar

+1

I am sorry you have so many problems. Usually a periareola incision is closed with a permanent suture to prevent spreading of the areola. When an implant is place, it can stretch the areola.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 16 reviews

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.