Its been now 2 years since my surgery and the scar is more noticable than before. I went to the surgeon that did the procedure and he told me their was nothing more he could do. I am very upset as I was so excited to get my implants. Now I am faced with this. The aereola shows through my bra, and when wearing a bikini top I feel as if everyone can see my imperfection. Please help with any solutions you may have.
How Can I Get Rid of Enlarged, Scarred Areola After Breast Augmentation?
Doctor Answers (32)
The areola can be reduced and/or the scar tattooed
Dear lady, you mention two problems : the visible scar around the areola (were they lifted together with the augmentation?), and the fact that your areola shows in a cutout bra.
Correcting the scar is perfectly feasible by a skilled medical tattooist or someone with experience with micropigmentation. Ask for references. This will however not reduce the size of your areola.
To make the areolas smaller, a "round block" technique needs to be used, where a donut-shaped segment of areolar skin is removed and a permanent purse-string suture is placed around the areola to prevent it from widening again. This usually works quite well. Downside is that you may feel the suture slightly as a thin "ring" under the skin at the edge of the areola.
Treating depigmented white scars
The photos show a white depigmented flat scar surrounding the areolae and a smaller left than right areola. Aside from the right left asymmetry and the color of the scar the result looks good. I don't know how anyone could see that difference through a bikini. The different sized areolae could be visible through a thin bra but that would not usually be for public view.
You apparently had a doughnut of tissue around the areolae removed at the time of the augmentation, doughnut mastopexy. That lift procedure is only feasible when smaller amounts of lifting are required as if you overdo the lift with it you get corrugated skin around the areolae and front to back flattening of the breast. Even if you do not overdo or try to use it for greater amounts of lifting you can still get stretching or enlargement of the areolae as a result of the procedure. To prevent that most surgeons place a pursestring suture deep in the skin surrounding the areola. This suture shrinks the outer size of the doughnut to match the inner size of the doughnut i.e. the areola circumference. This sutures frequently cause swelling of pouting outward of the nipple areola complex that can last for months. Also the suture can loosen or break and if this happens on one side that side areola will end up being stretched out and larger as appears to be the case on your left side. That can happen with any surgeon-good or bad. The only solution here is to re-operate and replaced the pursetstring suture.
As for the depigmented line you have around the areola I would not recommend cutting it out because you will most likely end up with the same thing or worse. Your options for this are cover make up. tattooing, concentrated pigment cell spray grafting of the depigmented area and excimer laser. The tatto artist has to be a medical tattooist not the ones that tattoo anchors on people. Concentrated pigment cell spray involves abrading the white areas raw, harvesting some skin from elsewhere on your body, processing that skin to enrich the pigment cell content and then spraying it on the raw skin surface. This is time consuming and laborious. The excimer laser stimulates skin pigment cells to migrate into the lasered area of skin. It works best if the width of the depigmented area is only a millimeter or 2. In your case I would think that would be your best treatment.
If you had a pursestring suture that loosened or broke that should be fixed before treating the depigmented white scar.
AREAOLAR SCAR REVISION
Thanks for the photos. They are very helpful. It appears that you have healed with depigmented circumareolar scars or more simply scars that have lost their natural color. A surgical revision of the scars may help but there may be only minimal improvement. The only other option to return the color to the white depigmented scar would be to consider tattooing. I do not feel any type of scar therapy will be helpful.
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Scar Correction Around the Areola
Web reference: Http://Www.Elpasoplasticsurgery.com
You may want to see a very skilled and reputable tattoo artist. Ask a breast reconstruction PS in your area who they recommend.
Consider a scar revision
Every person heals differently and will improve over the next 3 to 6 months. If your scars have widened then you may want to consider a scar revision. Some patients require up to one year to fully mature. A nice scar starts in the operation room. The incision must be placed in the right position, sutured keeping the tension off of the skin itself. Also it has been show that keeping the incision taped for the first three weeks keeps some of the early tension off of the scar. Then from the end of the third week to the end of the third month it helps to use a topical product with silicone.
The Area of Depigmentation Can Be Tattooed With Lasers
From reviewing your pictures, it appears that you have had a donut mastopexy in combination with a breast augmentation. This procedure is performed when mild breast sag is present and is done in an effort to avoid vertical and transverse skin incisions. Unfortunately, closure of these wounds under tension, can occasionally result in spreading peri areolar scars.
Although your post operative pictures don’t clearly show the quality of your scars, it’s obvious that there is some spread and depigmentation of the scars. Without the ability to perform a physical examination, it’s difficult to know what treatment is best for you.
The spread of your scar is relatively mild, and attempts to make it thinner, might actually result in a more noticeable scar. The underlying problem is tension on the wound closure and this has effectively not changed with scar revision. In other words, the same problem could occur again and possibly be worse following a scar revision.
Because of this, strategies designed to disguise the appearance of the scar, might be appropriate. Possibilities might include tattooing the area of depigmentation and treatment with lasers. It would be appropriate to consult your plastic surgeon. His insights will help you determine the best course of action.
It looks like you had a circumareolar lift (also called the Benelli or Donut lift). You have a few suture marks on the left side, and a slightly wider areolar diameter, in addition to a scar that goes all the way around the areolar area.
Although the photos are not the best, the scar doesn't seem depressed, tethered, heaped up, or especially widened. Overall, the scar quality is reasonably good - it doesn't appear to be a keloid or hypertrophic scar.
While you could have the scar cut out and re-sutured ("scar revision"), the results might not be that much better.
Using a permanent internal suture might help to prevent the areolar size from stretching back out, but even in the best of cases, that can happen 10-15% of the time.
Areolar size can be reduced
Breast augmentation typically enlarges areolar diameter. An option to consider is a peri-areolar donut mastopexy to reduce your areolar diameter. The technique employs a GoreTex suture which 'locks in' the diameter of the areola. I've done this a few times to revise patients like yourself. It works fairly well.
Most likely, the result of any scar revision will be the same. Tattoo is a good option in this case.
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