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Staging Breast Lift and Augmentation to Avoid Stretched out Areolas?!

As the picture indicates, not only are my breasts sagging from fluctuating weight (which is under control now), but my areolas are the size of hubcaps! I want to get a lift plus and implant to regain my size, but I'm afraid of stretching out my areola because my skin is so loose--even if the circumference is trimmed during surgery. Would I decrease the chance of huge areolas by staging the procedures, getting the lift done first? -34C, never had kids, petite (5'9" 130lbs), super fit, South Asian/Indian

Asked 25 months ago by ptoticpremed in Ohio

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areola nipples 130-149 lbs 5 ft 8 in to 6 ft 0 in Asian stretched weight gain

Why would you want an implant?

You already have C-cup breasts and judging from the photo, they are more than adequate in volume for your body. Just get the lift. It will last longer, the scars will be better, and it will sag less over time. Remember, if you are saggy now with the existing weight of your breasts, then you will sag even more in the future if you add more weight to your breasts.

Steven Teitelbaum, MD

Los Angeles Plastic Surgeon

ASAPS

Staging breast lift and augmentation

By its very nature, a breast lift is a skin reduction procedure while a breast augmentation adds volume. This increase in volume places tension on the skin and scar. Anytime you place tension on a scar, there is a risk of scar widening. While I agree with my colleagues that placement of a permanent suture may decrease this risk considerably, scar widening is still something to consider. If you went with the combo procedure of a "donut" lift/augmentation in one stage, going... more

Andrew Jimerson, MD

Atlanta Plastic Surgeon

ASPS

No benefit to staging implants plus lift

There is a lot of debate among plastic surgeons as to the merits ot doing a breast lift and augmentation in one stage or two, but stretching of the areolas isn't typically one of the issues. The simple answer is that using a permanent stitch will prevent enlargement of the areola, but there is a trade-off. Under normal circumstances, the areola will expand and contract depending on temperature, stimulation, and so forth. A permanent stitch inside will prevent this too, so instead of... more

Richard Baxter, MD

Seattle Plastic Surgeon

ASAPS ASPS

No "normal" areolar size

Breast lifts are for ptotic breasts - they are defined as a nipple that is below the inframammary crease, although your breasts look slightly saggy, they are not truly ptotic. From the side view it appears as if your nipples are above the IM crease. Secondly, there is no "normal" areolar size, they are usually fashioned to be between 4 - 5 cm in diameter after a reduction or lift, but some women's areolas are over 8cm in diameter and for them that is normal. Perhaps only an... more

William B. Rosenblatt, MD

New York Plastic Surgeon

ASAPS ASPS

Staging the breast lift and augmentation to avoid stretched areolas?

I don't believe an experienced aesthetic breast surgeon would need to stage your procedures. While there is no assurance the final areolar diameter would be decreased following single or staged surgery, it very likely would. Most importantly, patients are very pleased with the added fullness following augmentation and tend to be less concerned with areolar diameter.

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Eric Pugash, MD

Vancouver Plastic Surgeon

ASPS

Breast implants and breast lift should be done together.

Hi. They are not like hubcaps! Seriously, a well done simultaneous breast lift with breast implants will give you good shape and size and will permanently make your areolas smaller all in one stage.

George J. Beraka, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Timing Breast Lift with Implants

Hi there- Having done a very large number of aesthetic breast procedures, I would say that your chances of ending up happy and avoiding the problem you are concerned about are maximized NOT necessarily by staging the procedures you describe, but by altering the plan. In my opinion, circumareolar breast lifting is only appropriate for women with either a very pointy central breast, or who have a very minor amount of excess skin and need only minor nipple relocation. With the techniques you... more

Armando Soto, MD

Orlando Plastic Surgeon

ASAPS ASPS

Breast lift and augmentation staged procedure

You can undergo a staged procedure which might reduce the chance of the areolae stretching, but there's no guarantee of this. It's certainly possible to do a combined lift and augmentation through the areolae, at which time the areolae can be reduced to a size that is acceptable to you. There may be some mild stretch with time, perhaps within a few millimeters. If this is accpetable, I would suggest just doing the procedures together. Keep in mind that if you do have children in the... more

Nina S. Naidu, MD

New York Plastic Surgeon

ASPS

Avoiding stretched out areolas

I love it when a patient "gets it"!!! You are right on in your decision from the scenario you have presented. Go see 3 boarded plastic surgeons in your area to show them what you have decided to see if they agree. Regards from MIAMI

Darryl J. Blinski, MD

Miami Plastic Surgeon

ASPS

Staged lift and augmentation

There are a number of ways to do a lift procedure and a number of ways to try to limit the spreading of the areola. The one thing that has always intrigued me is why do a staged procedure to try to avoid the areola spread that might happen with a single procedure when in fact, the staged procedure does not guarantee that the problem will not occur and the single non staged procedure may not have the nipple spreading. If you do it in two stages you are guaranteed to have two procedures. If... more

John P. Stratis, MD

Harrisburg Plastic Surgeon

ASAPS ASPS

Staging a breast lift with augmentation may prevent stretching of the areolas

Hello - You're absolutely right...staging your lift and augmentation may help to prevent stretching out of your areolae. This really depends on the size of the implants that you desire. If you don't want large implants, you may not need to stage anything; however, if you want breasts that are pretty big I would recommend staging the procedures. For the staging, I would recommend waiting at least 3 months before proceeding with the next stage. Good luck!

Jeffrey E. Schreiber, MD

Baltimore Plastic Surgeon

ASPS

Combining breast lift with augmentation

A combined breast lift and augmentation is arguably one of the more difficult operations in Plastic Surgery. There are three options for the lift: a peri-areolar lift (donut mastopexy), a vertical mastopexy (lollipop lift), and the anchor incision. Each has their advantages: The peri-areolar lift (donut mastopexy) has the least amount of scarring and involves just an incision around the areola. Stretching is prevented by the use of a permanent, purse-string suture. The problem with this... more

Robert M. Jensen, MD

Medford Plastic Surgeon

ASAPS ASPS

Breast lift ways to avoid areola stretching

There are several ways to try to prevent the possibility of areola streatching: Avertical mastopexy and an implant is ideal for you and that will not stretch your areola. A periareolar lift with lift interlocking permanent sutures may not stretch the areola, NO GUARANTEES. The danger in combination breast lift and breast augmentation is more the loss of skin and loss of nipple areola.

Samir Shureih, MD

Baltimore Plastic Surgeon

ASAPS ASPS

Circumareolar lift can decrease the size of the areola

We use a circumareolar mastopexy both to place the implant and to reduce the size of the areola. The final incision is 360 degrees around the areola. Using a permanent suture to secure the areola at the desired diameter is an excellent way to avoid the stretched out areola. Review this option with your surgeon ahead of time. Best of luck.

Francisco Canales, MD

Santa Rosa Plastic Surgeon

ASAPS ASPS

Timing of a lift and augmentation

You can stage them if you like or you can do them at the same time. It is fairly common to perform a circumareola lift and reduce the areola size while performing a breast augmentation in a patient that needs a small lift.

Steven Wallach, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Breast augmentation and lift

All lifts reduce the size of the areolae and are designed to stabilize this smaller size. When done properly, the areolae do not usually stretch back to a large size, though, with poor tissue, it is possible. From your pictures, all you need is a periareolar mastopexy (one that reduces the size of the areolae and lifts the breasts an appropriate amount) and the augmentation. The majority of skin removed would be from the areolae with, perhaps, some from just above the present areolae. This... more

Robert T. Buchanan, MD

Highlands Plastic Surgeon

ASAPS ASPS

Breast Lift & Augmentation: timing, sequence and size of the large areola

As Dr. Rand has suggested the use of a permanent suture tends to minimize the stretching of the areola. Furthermore staging the operations does not mean that the areola will not stretch with the second surgery unless the implant is placed first and the lift is done second (an unlikely sequence of surgery).

Otto Joseph Placik, MD

Chicago Plastic Surgeon

ASAPS ASPS

Lift and combined breast augmentation

In your case I would recommend a periareolar lift and submuscular augmentation. Because I use a permanent suture to keep the final areolar size stable, I would not do these as separate surgeries as it isn't necessary. I have many photos of this on RealSelf.