What is the Truth About the Benelli Lift/areola Reduction? Does It Make Areola Stretch More?

The problem is that in women who truly need a vertical or full mastopexy, but refuse to have the incisions that these operations require, we as surgeons tend to compromise and subsequently will push the limits of this operation. When we as surgeons try to push the limitations of an operation like the Benelli lift, a number of problems can occur, such as stretching or spreading of the areolar complex.

The reason for that there is no general consensus with respect to Benelli Mastopexy, is that there is commonly a misunderstanding between patients and their surgeons about what this particular operation can achieve. There are many types of breast lift operations available, however several of them require an incision be placed either on the front of the breast, in the inframammary fold, or both. Many patients that I see would prefer to avoid these incisions, choosing to have circumareolar (aka Benelli) lift incisions instead. 

 

 

 

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The goal of every breast lift should be to 1) minimize length of scars, while 2) maximizing quality of scars and 3) maximizing breast shape.  For the ideal patient, a periareolar lift is a fabulous operation.  However, trying to get too much lift out of a periareolar lift can leave a poor quality "purse-string" scar and a flattened breast shape.  

In my hands, the ideal candidate for a periareolar scar approach has slightly "cone shaped" breasts that can be flattened a little without negative consequences and requires only a couple of centimeters of nipple elevation.

You WILL get differing views about the Benelli lift, but certain issues are clear.  If the breasts are very low, a Benelli won't work and you need a full or T anchor mastopexy, to decrease the amount of skin while lifting the breast tissue, making a new skin brassiere and repositioning the nipple/areolar.  The Benelli lift does flatten the front of the breast.  To prevent areolar widening a permanent suture must be placed around the areolar and it depends on the patients skin quality and thickness whether this is visible or can be felt under the skin.  This suture can become exposed, infected and need removal, leading to lose of the support it was supposed to provide.  An anchor lift will reliably give an excellent lift and shape to the breast, without the need for permanent sutures and deforming the front of the breast.

Benelli described a periareolar breast lift technique that bears his name, yet many surgeons perform some sort of periareolar lift that differs from the details Benelli himself describes. In other words, some surgeons do a slightly different lift technique, and also use different suture materials, each of which can have a bearing on the answers you are receiving. Every surgeon who DOES something different will be truthful in SAYING something different.

Here's the skinny: If a premanent suture is used (like Benelli described), there will be less (theoretically none) areolar stretch, since the suture does not stretch or dissolve. Obviously, there are still limitations to the amount of "lift" that can be achieved with this procedure, and the net result is usually some degree of areolar flattening, as well as some degree of scar irregularity dependent upon how large of a circle is "purse-stringed" to a small(er) diameter areolar circle (Hence, the minimal degree of lift possible).

To avoid the visible suture (which can sometimes be FELT as well), some plastic surgeons have used other suture materials. Disssolving sutures lose their ability to "block" the areolar stretch that always occurs without a permanent suture, so some surgeons choose a very long-acting dissolving suture like PDS, hoping that the healing and stability of the suture line is established if the stitch is present for "long enough." I have tried this, and it generally doesn't work. Shorter-acting dissolving sutures are even quicker to allow areolar stretch, which is not only faster but more severe!

So most of us who still perform Benelli or modified periareolar lifts in select patients will use some sort of permanent suture to avoid the stretch, but unfortunately which can be seen or felt in some patients. I have found the best compromise between these opposing issues is satisfied by use of a Goretex suture, which is a permanent suture, but one which is microscopically porous to allow tissue ingrowth and fixation, and yet soft and somewhat "stretchy," which decreases the visible and palpable suture presence after this kind of lift. This is further enhanced by trying to place the suture in the deep dermis and taking many small bites with the suture. Still, some patients have thin skin and the stitch may become visible, especially after swelling diminishes!

I presently perform few Benelli or periareolar breast lifts because I do not like choosing between these two not-so-desirable alternatives, and because if you are a candidate for a minimal lift, you might well be a candidate for no lift at all. If you really need a lift, then you may be better served by a "full" lift that truly shapes the skin brassiere and repositions the nipple/areola complex to its "proper" higher, lifted position. Best wishes!

Hello 7000xo,

The answer is 'it depends'. Unfortunately, the benelli mastopexy (lift) is the most frequently named surgery in medical malpractice cases for cosmetic breast surgery.  This is because surgeons use this lift in patients that are not good candidates, and are best suited for a vertical or full anchor mastopexy. Kinda scary to think that so many doctors don't know what they're doing, huh?  So, there are not just cases of re-expansion of the areola after this lift, but also severe pleating of the skin, flattening of the breast mound, persistent sagging of the breast, and thickened scars. 

Having said all that, I believe the Benelli mastopexy is an excellent technique for the right individual.  When properly applied, the areola are smaller, scaring is inconspicuous, and breast shape is excellent.

What you need to do is seek out a real expert in breast surgery, and preferably revision breast surgery.  These individuals are not likely the surgeons that churn out breast augmentation after breast augmentation. Those individuals are just the lowest priced guys in town, or the ones with the best PR.  You want a thoughtful, well credentialled individual who can not only perform a breast augmentation, but also repair complex implant/breast problems and perform full reduction and lifts.  Why?  Because if you are not a good candidate for a benelli lift they won't tell you that you are just because that's the only procedure they can perform other than breast augmentation.   Certification with the ABPS and membership with the ASAPS is just the baseline, but a manditory requirement.

Best of luck!