I would like to get areola reduction surgery to reduce the left areola circumference to match the right one. What is the best placement of the incision for the best (least noticeable) scar result? As you can see, my areola has a "soft" edge that I would like to keep to match the right one but I see most scars are outside the areola itself and I don't thick that will look natural. Can the scar be on the areola itself and how do those usually turn out?
What is the Best Scar Location for Areola Reduction?
Doctor Answers (5)
Incisions for areola reduction
Having considered this question off-list and analyzed it fully although not tried it, I think, contrary to Dr. Placik, that the areola could be reduced in diameter with the incision just inside the edge but only if the nipple-areola is not moved up. If you elevate the nipple-areola to a higher level to match the right side, then the edges of the incision would have to border normal skin.
Areolar Reduction Scar Considerations
The best incision for areola reduction would be at the edge of the areola when finished. If for any reason you feel a concern because of poor color match then a camouflage tattoo can be performed to match the scar to your existing areola color.
Areola reductions leave the scar along the border of the areola and the breast skin. The scar usually heals quite well.
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Reduce the areola.
The scar has to be on the edge of the areola in order to reduce the size. Any scar inside the areola will keep the outer rim the same size.
Surgical options for breast asymmetry
For the average woman between 5 and 6 feet tall the desired breast proportions are that the nipples form an equilateral triangle with the upper notch of the breast bone and each side of the triangle is about 20cm in length. Additionally the distance between each nipple and the fold under the breast should be about 7cm with a gentle curve outline along the bottom of each breast. The breast tissue should also be centered under the nipples in the positions described. Together with equal sized nipple areola complexes of about 4cm in diameter this creates the left right symmetry and aesthetic look we strive for. The question then arises as to how one achieves this goal or result after breast surgery. The answer depends on where you are starting from or how far the patient's proportions differ from the ideal.
In your case the left nipple lies at a lower level than the right, the left areola is larger than the right, the nipples point off to the sides rather than straight forward and the majority of the breast tissue lies below the level of the nipples. I also suspect that fold under the breast is lower on the left than it is on the right. What should be done depends on how much surgery you want to have, whether you just want the left more like the right and the skin condition or laxity (which cannot be assessed from only a photo). You have a number of options available ranging from mastopexy without or without a breast implant to skin incisions and purse string sutures around the left areola. If you just cut out a rim or crescent of skin around the areola there is a tendency for the the areola and the scars around the areola to stretch more than the surrounding skin. I do not think you would be happy with such a result. There are many reasons that a scar around an areola are visible including stretching as mentioned, a slightly curved scar when the areola edges themselves are not discrete etc.
Sorry but there is no single quick answer to your question.