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For small lifts, a donut mastopexy is perfect. This does allow minor repositioning of the areola, with movements of about 1 - 2 cm. The donut lift will also decrease the diameter of the areola. The problem with this approach is that it lacks the power to provide a significant boost to the breast tissue, and there is a risk of scar and areolar widening over time, especially when adding an implant. I prefer to use a lollipop incision because this allows for repositioning of the breast tissue and a more powerful lifting effect. The downside is that it adds an additional scar to the breast in a visible area, but does not have as big of a risk of areolar spread over time.

I’m 40 y/o no children. Ht 5’6, wt 98lbs. I’m getting a breast augmentation with areola reduction. My PS recommended a donut lift with either 240cc full profile or 265cc. (I’m still undecided on size. I want to look very natural ) he said I needed full profile bc of my chest width. My main concern is the donut lift. I have seen many drs say avoid it but some say it works on certain ppl. He said it would give a slight lift, smaller areolas and reposition them. Is this something I should go forward with or would a lollipop be more beneficial for me?

Breast Augmentation with peri-areolar Mastopexy - would a donut lift or lollipop lift be more beneficial for me? (Photo)

A double fold, often called a banana roll, is a difficult area to fully correct. Improvements can be made, but you may always have some evidence of a depression a the smaller, higher fold. Some options that are nonsurgical include cool sculpting to reduce the fatty tissue between the creases, but this can be imprecise. Other options include fat removal with liposuction in the roll itself, combined with subcision - a procedure that releases any tethers from the muscle to the skin creating the second fold - and fat transfer. For severe double folds, a skin removal procedure combined with gluteal fold reconstruction may be necessary. Yours is somewhere in between and may be improved with liposuction and fat transfer with subcision.

Hello, I have extra rolls underneath my butt. How can I remove this?

Extra gluteal fold - how can I improve this area?:

Depending upon where your final scar will be, some, all, or none of the tattoo may be removed. I would suggest you wear your favorite undergarment/bathing suit bottom to your consultation to show your doctor where your scar should ideally be placed. If low in the bikini line, then likely the whole tattoo would be removed. I hope this helps you in your decision making process!

Interested in tummy tuck for diastasis recti, loose skin and fat removal. One doctor told me the tattoo was no issue, another told me it would be “cut in half”. Can it either be removed completely or avoided somehow Entirely? Getting conflicting responses.

Can my hip tattoo be removed or avoid during tummy tuck? (Photos)

Thanks for your question. This is a big decision, and I appreciate you taking your time to be thoughtful about the size you choose. The best way to choose is to try on sizers in the office. Some offices may even offer a sizer that you can wear at home and inflate to different volumes (ours is called the Dazzle) to try on in your usual clothes and take for a test drive. A 50 cc difference distributed over your whole breast is not a big change in size, so when my patients express anxiety about possibly going 'too small' I will encourage them to lean into the slightly larger size to avoid the most commonly reported post-op regret of not going bigger. Your anatomy is also important - and picking an implant that fits your 'base width' or measurement of the breast width should also be taken into account, and is something to discuss with your surgeon. You have great anatomy for a breast implant, and I wish you the best luck on your journey!

Hi! I am looking for some advice I have had my consultation but I came away feeling unsure after some further research. I honestly don’t know what cup size I am as I don’t wear bras I think around a 32A. I have been recommend 235cc sub muscular, I was offered the option of 275cc but at the time I thought it may look fake and too big. I am 165cm and 50kg. I have a petite and athletic frame I want something natural but also don’t want to be underwhelmed and regret going so small (as I have heard many reviews people say they wish they went bigger). Any advice on which option would be best suited I think there’s about 2cm grab on the right and 3.2cm grab on the left when she did the pinch test.

Petite and athletic frame - I want something natural but don't want to regret choosing too small. 235cc or 275cc? (Photos)

Thank you for your question. Your umbilicus is hooded, which suggests that you have skin laxity above your belly button and a small amount of excess fatty tissue also. The correction you see with your back arched puts your umbilicus on tension, and mimics what a skin removal surgery (abdominoplasty, reverse abdominoplasty or mini abdominoplasty) could accomplish. I tend to agree with the surgeons you have seen, as you do not appear to have a significant amount of skin excess to justify a full abdominoplasty. Your umbilicus is also positioned high on your abdomen, so would also make sufficient skin removal and scar placement for a traditional full abdominoplasty less than ideal. Options that may improve the appearance include liposuction with the addition of a skin-tightening modality such as renuvion or smart lipo to assist with upper abdominal skin contraction. A mini-tummy tuck involving a floating navel will help to tighten the skin and can result in a more vertically oriented umbilicus, but it will also move the umbilicus lower on your abdomen. Best of luck in your journey!

I am 5’4 and 110 pounds(i previously was 142 like 8 years ago). I have an arrow shaped/ frowning bellybutton that I really don’t like. I have done lipo consultations and they said that I have some loose skin but they could get rid of the fat in the area, but it might not make the shape better. I have also seen a lot of lipo patients where their belly button is more horizontal after lipo. I asked about a mini tummy tuck but both doctors didn’t feel like i had enough skin to justify it &amp; most of my skin laxity looks like it’s above my bellybutton. I have seen doctors not in the US that do sole umbilicoplastys to change the shape of the bellybutton, but would that help? I have also seen floating navel tummy tucks, and I like those because my bellybutton is really high on my stomach as well. Would an umbilicoplasty help in this case? Or the floating navel tummy tuck? I like how my bellybutton looks when i arch my back and stretch out my stomach, so ideally if there is a way for it to look vertical like that, that would be best (but i’m unsure if possible).

How can I make my bellybutton more vertical? (Photos)

Thank you for your question and for including the photograph. It looks like your mons pubis - the soft tissue covering your pubic bone, has been pulled too tight. Usually I like to keep about 7 cm between the vulvar cleft and the incision for the abdominoplasty to prevent issues like this from occurring. I would recommend a revision to try to advance the tummy skin and the abdominal scar lower to reposition the mons tissue lower. After 4 years, this may not fully reverse the issue but is likely the best way to reverse this problem. You can also consider some fat transfer to increase the bulk of the labia majora, but this will not lower the vulvar cleft. I encourage you to seek out your surgeon to explain your concerns and see what options you may have.

I had a tummy tuck about four years ago and though I’m really happy with the results, I’m not crazy about the fact that my clitoris shows now. My upper labia(?) don’t come together to cover it. I used to work as an artist’s model, but when I look at myself in the mirror I see that there’s no way I could ever do that again! Is there any way to fix this?

Tummy tuck exposed clitoris - is there anyway to fix this? (Photo)

Breasts progress through a very normal and relatively predictable change in shape from the immediate post op period through the first year after surgery. At first, breasts are swollen, ride high on the chest wall and may resemble an augmentation. This settles in the first 1-3 months, and the breast resumes a more natural slope with the majority of the breast tissue at the level of the areola and below. Usually these changes stabilize between 3-6 months post-op and any additional changes are slight. This suggests that the results you see today are as close to the final result that you will be after your surgery. If the appearance of your breasts today are not satisfactory to you, you may want to consider sharing your concerns with your surgeon and discussing options. Addressing these concerns will likely require a discussion about surgical options.

I got my reduction on 3/8/24. And it went fine. Had a small infection on one nipple. But other than that went great. Went from 36H to like 36D now. And I feel like they’re still kinda boxy and one has an indent on the bottom where the scar is. Will this settle eventually? Or will I need to go see a surgeon?

1 year post-op, breasts still seem a little boxy, and scar is a little indented (photo)

Thanks for your question THolland, any time a patient has a finding that may impact bleeding risk, I recommend consulting with a hematologist prior to your surgery. This specialist is trained in different types of bleeding and clotting disorders and will be able to give you the best idea of your risks with elective surgery, as well as make recommendations about how to mitigate those risks. Hematoma after breast biopsy is not uncommon, but can raise concern about bleeding risk for future procedures. In your case, MTHFR mutation may actually increase your risk of having blood clots after surgery. I highly recommend you discuss this with both your surgeon and a hematologist prior to your surgery. Best of luck with your journey! - Emily Wirtz, MD

I recently found out I have the duplicate gene mutation MTHFR with 2 copies of the 1298 gene. I am scheduled for surgery in Feb 2025 and am hesitant to move forward with surgery. My Dr also told me I have LP(a)- not sure what it's role would play in surgery. I am very anxious about my procedure as I recently had a breast biopsy done and had complications from that; found I have PASH and also developed a hematoma the size of a baseball. Can any of this hinder recovery for plastic surgeries?

Possible complications with MTHFR gene mutation?

Hi watermelon6319, assuming you have healed fully from your laparotomy, and that you have obtained a form of clearance from the surgeon who performed your procedure, you may be a candidate for abdominoplasty surgery. It’s important that the original condition has been fully treated or is stabilized, and that you are back to your baseline health before putting your body through another demanding surgery. Skin removal with abdominoplasty can remove a significant portion of the scar in the photographs, but you may still be left with a short vertical scar right above the pubic area.

I recently got a laparotomy in Nov of 2024. Am I a candidate for a tummy tuck? Would the scar be taken away? (photo)

Emily C. Wirtz, MD

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Dr Wirtz is AMAZING!  She’s done 2 procedures on me and I’d go back again! My breast reduction and panniculectomy both had very little pain and recovery was quick.  100% success- results are beyond expectations!  I cannot believe that some of the scars are nearly invisible after just 6 months.  Already sent family to her.   Highly recommend

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Meet Emily C. Wirtz, MD, a trusted Board Certified Plastic Surgeon. See 9 expert answers, 24 before-and-after photos, credentials, treatments, and 1 real patient reviews. Book a consultation today!

Plastic and Reconstructive Surgery, University of North Carolina Chapel Hill

Aesthetic Plastic Surgery, H/K/B Charlotte, NC

B.A. Economics Northwestern University, Cum Laude

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