How Can I Get Rid of Enlarged, Scarred Areola After Breast Augmentation?

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.

Doctor Answers (34)

The areola can be reduced and/or the scar tattooed

+3

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.


Belgium Plastic Surgeon

Treating depigmented white scars

+3

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.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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AREAOLAR SCAR REVISION

+3

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.

Todd B. Koch, MD
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Scar Correction Around the Areola

+2
While you periareolar scars are acceptable, they could be improved. If they are raised, a CO2 laser could help to flatten them. Steroid injections help, but you may develop a widened scar. Silicone taping usually works earlier in the recovery period. Tattooing is a good way to camouflage the scars it they are flat.

Frank Agullo, MD
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Pale areolar scars after a breast augmentation

+1
It appears in your case that they attempted some type of purse string procedure at the time of your breast augmentation. Some surgeons will do that to attempt to lift or reposition the areola, or to reduce the size of the areola. In either regard, what it appears has happened is that the pressure behind the areola has stretched the scars out and they are pale or what we call hypopigmented. I think surgical scar revision is likely not going to leave you any better and I think that a skilled permanent make up person can certainly place color into the hypopigmented scar and make it look much better. I have a lady that does that type of work in my office and I am sure you can find someone in your area as it is commonly done for patients after breast reconstruction.

Julio Garcia, MD
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Areolar scarring

+1
You can have your areolae reduced by repeating the procedure, but they are likely to stretch again over time. The scar is flat and relatively thin. You could consider a scar revision, but it would likely be a minimal improvement (and it would take time to fade, just as it did after your initial surgery). If you are concerned about the white appearance of the scar, consider tattooing. Best of luck.

Grant Stevens, MD
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Breast Augmentation

+1

You may want to see a very skilled and reputable tattoo artist.  Ask a breast reconstruction PS in your area who they recommend.

Best,

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
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Consider a scar revision

+1

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.

Jeffrey Zwiren, MD
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The Area of Depigmentation Can Be Tattooed With Lasers

+1

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.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
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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.