Vertical lift is almost always better
Even without measurements, I can say that a vertical breast lift (lollipop) will give you a better shape and longer lasting results with the most predictable scars. You are actually a decent candidate for the circumareolar lift, but you would still do better with a vertical mastopexy.
Circumareaolar lifts are overused
In general it has been my experience that circumareolar lift procedures are overused. In an effort to avoid scarring from a more extensive lift procedure, or the time, cost, or recovery associated with another type of lift, a circumareolar lift is selected and then "forced" to deliver results that it can never hope to deliver. As a number of my colleagues here have already said, a circumareolar lift is a limited procedure which can only produce a small amount of actual lift - perhaps 1 - 1.5 cm comfortably, or repositioning of the nipple, and it virtually does nothing to reposition actual breast tissue that is below the inframammary fold. The more we try to demand of the procedure, the more we see things like flattening of the center of the breast, widening of the areola or the periareolar scars, rippling and pleating of the skin around the scar, and bottoming out of the breast volume. While it is impossible to say for sure without examining your breasts in person, just based on the images you have shown, I would have concern that your areolae are too wide, your tissues are too lax, your nipples are too low, and you have too much breast gland ptosis, or tissue below your fold, for a circumareolar lift to deliver optimal results. Good luck.
Circumareolar vs. lolipop mastopexy and implant.
We hear this request all the time. Volume and fullness, (from the implant), and lift. It is difficult to say without a true exam. Their may be trade-offs, size, shape, scar. Board certified plastic surgeons may have different opinions depending on their training and experience. Make sure that you have reasonable expectations. Also ask if the surgeon who is just thinking circumareolar mastopexy if he/she might put the vertical scar on if there is excess tissue. Together you will come up with a plan that is right for you.
Am I a candidate, and will I achieve good results with a circumareolar mastopexy with augmentation?
I think a vertical lift will manage your anatomy better than the periareolar lift.
Kenneth Hughes, MD
Los Angeles, CA
Thank you for your question and for sending photos. The circumareolar scar can work well in patients who require a very small lift and/or reduction in areolar size. Though the idea of a scar only around the areola sounds attractive, this technique tends to flatten the breast. Also compared to "lollipop" or "anchor" techniques, the resulting scar has an irregular texture and takes longer to flatten out. As Dr. Kirby noted below, this scar tends to widen, especially when an augmentation is done with the lift. The "lollipop" or "anchor" techniques allow the surgeon to better shape the breast and give the breast more projection. Since both surgeons who examined you were board certified (and I would assume comfortable with all options of breast surgery), I would go with the surgeon who suggested the "lollipop" approach.
This is really a instance where the physical exam is key in determining a final recommendation. Either lift may suffice depending upon what your expectations are, acceptance of scars, final breast shape desired, and size of areola. Glad to help.
Lollipop lift not circumareolar best for significant breast sagging
Thank you for your question and photograph. Of course an in person examination and consultation is necessary to properly answer your question. That said from your photographs it appears you have significant breast ptosis and a vertical mastopexy or lift such as a lollipop or anchor we'll likely give you the best result when combined with breast augmentation
Circumareola or lollipop lift
For me, the choice to do one or the other really depends upon your measurements and how much laxity you have. Best to be seen in person.
A circumareolar lift leaves the scar around the areola, which can widen over time, especially if a large lift is planned and if a larger implant is used. It is a difficult scar to control post-operatively and often results in revisions. A full lollipop lift will give you more support in the long run. Compared to the circumareolar technique, which relies on the skin alone to support your breast and new implant, the lollipop lift gives you support from the inside. If you are considering the 400cc implants, the lollipop lift will definitely give you the support you will need. A circumareolar lift will likely stretch considerably and fall over time. Best of luck!