In my reading the Q/A in realself, I came across a PS that said African americans should NEVER use an areola incision beacuse of scarring. this has really bothered me because i was finally happy that I didnt have to have the lollipop scar and I thought this scar would be much less noticable. I also have very large areolas and my PS is making them smaller. Please let me know if I will absolutely have terrible scarring or does it vary from cast to case. Also, 400cc too big for Benelli lift?
African American Worried About Benelli Lift Scar, What Can I Expect?
Doctor Answers 15
Breast lift scars in an African-American woman.
I have performed breast lifts on African-American, Hispanic, Asian, and Mediterranean women for 25 years, and the worst scars I have ever seen were on a lily-white Caucasian woman! The risk of hypertrophic or keloidal scars is slightly higher in patients of color, but the vast majority of women of any race undergoing breast lift will have very nice scars after they heal and mature fully. Just look at the photos in my breast lift spotlight, on my RealSelf photo page, or on the link below for one of my patients with dark skin and good scars (full breast lift).
However, you could have the genetics that might lead to thicker, wider, or worse-appearing scars, particularly if you have these elsewhere on your body.
The reality is that often patients are seduced by the supposed simplicity and "less-scarring" design of the periareolar-only Benelli scar, which is suitable only for patients who need a minimal lift. If a more substantial lift is needed, trying to make a much-larger circumference purse-string to a much-smaller areolar diameter causes far too severe mismatch, causing pleats in the skin as the outer large-circumference cut is "gathered" to the smaller-circumference desired areola size, and creating MORE irregularity in the precision of the suture closure. This lack of skin-skin accuracy is actually a stronger cause of inflammation and irritation which stimulates bad scarring--the very thing you are trying to avoid!
I agree with Dr. Rand that sometimes those who try for Benelli lifts when a full lift would actually be more precise, accurate and with better skin tailoring end up with the problem scarring they sought to prevent!
As far as size, 400cc may be too big if your skin brassiere after lift is too tight. The fact that your surgeon is considering a Benelli "lift" suggests that perhaps a lift is not needed at all, although your areolas would still be very large. Perhaps other opinions with ABPS-certified plastic surgeons may help to clear up your questions and concerns. Best wishes! Dr. Tholen
How Bad Will I Scar?
African Americans or anyone with darker skin color are at a higher risk for developing hypertrophic (excess scar) or even keloid (severe overgrowth of scar) scar formation. Higher risk does not mean "for certain". Many things determine your risk including a personal or family history of poor scar formation. We have performed hundreds of surgeries on many different skin colors and types and have found that many end up with beautiful scars. Without seeing photos it is hard to give you specific advice. If your areolas are very large, then a Benelli lift may not be appropriate because of the high risk of scar widening or stretching. If you are not certain or comfortable with the choice your surgeon gave you, then seek a second or even a third opinion.
Breast lift scars for a dark skin tone
There are risks for hypertrophic scars and hyperpigmentation with a breast lift, and they can actually occur in all skin types, though as an African American we can understand your worry. The risk is not greater or less than with breast reduction, and we have a fairly broad experience which indicates the risk is present, though not for all, even with a darker skin tone. If the areola is very large, relapse or sretch is reduced with the vertical pattern. Look at many postings and photos of individuals like you to get an idea of how things have worked out for others.
Best of luck, peterejohnsonmd.com
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Benelli lifts are often over prescribed
The worst results from Benelli lifts are in those folks who really needed more but were afraid of the scars. It is ironic because usually the full lift scars are well accepted while a majorly pursestringed scar (big areolas and a Benelli) will never make a great scar because of the logistics of the difference between the outer and inner circle diameters.
African American Breast Lifting Scarring?
Thank you for the question.
The vast majority of African-American patients who undergo breast lift surgery ( of any type) will do well with scarring. A small percentage will have problems with hypertrophic or keloid scar formation. Unfortunately, there is no way to predict for sure which patients will have the abnormal scarring.
It will be important to choose your plastic surgeon carefully; it will also be important to make sure you are a candidate for Benelli breast lifting. This is an operation that provides very minimal breast lifting and can be problematic if performed on patients who are not good candidates for minimal breast lifting.
In other words, if a plastic surgeon tries to “do too much” with this operation, the potential abnormal scarring and/or spreading of the areola increases. These complications will occur regardless of patient ethnicity.
I hope this helps.
African American and Breast Lift Scarring Concerns
The key to success lies in letting you surgeon know specifically what you would like to look like following the surgery. For example, how perky do you want to be, what shape do you want to have, etc.? However from your description it would appear that a lollipop type lift would be best for you rather than a periareolar lift like the Benelli procedure. Here is a rule of thumb that works for most patients. If you nipple is above your lower breast crease then often a periareolar lift will be sufficient for most patients. If your nipple is at or below your crease then a vertical lift (lollipop lift), inverted T or anchor pattern may be required.
The Lollipop incision for Grade 3 or 4 ptosis (areolar near or below your breast crease) works best in my hands and the use of a Lollipop technique can lift your breast to the perkiness you desire. However, other plastic surgeons are more comfortable with an inverted T or Anchor Pattern technique.The donut lift does tend to both flatten and have scars widened as you are removing skin around the areola which causes tension in that single area causing it to "spring' apart over time. With the Lollipop incision the tension is spread out over a greater distance of the lower vertical scar (where the areola once was) causing less tension on the areola and entire closure. The vertical lift tends to cone the breast making it more shapely (conical) and less flat. For a visual take a paper circle, cut out a small wedge on the bottom and bring the edges together to see this effect. In general I would pick the best Surgeon and explain fully what you want to achieve rather than the technique. Always choose a board certified Plastic Surgeon.
Benelli Lift Scar
African Americans should be wary of Benelli (periareolar) breast lift.
The best scars result when the incisions are closed with tension. A periareolar lift always is closed with tension. That's why I think it is seldom a good procedure in any patient but particularly African Americans.
If you have very large areolas you will need circumareolar incisions to reduce their size. However, if you have a significant amount of ptosis, this approach may not be enough. You will be better served if you would consider re-submitting this question with pictures. Techniques vary depending on what we have to work with and your desired outcome. I have personally operated on a high percentage of AA women with almost invisible scars around the areolas. It's all about technique and surgical skill of your PS.
Best of Luck,
Gary Horndeski, M.D.
African American and Binelli Lift Scar
You have very good reason to be concerned, but not necessarily because you are African American. While its true that some people of color tend to make thicker or keloid like scars, this is actually quite unusual on the breast unless there is some problem with wound healing. I do lifts and reductions on African Americans all the time and they get very satisfactory results.
It is a misconception to think that a Binelli Lift always results in a lesser scar. As Dr. Rand pointed out, the very worst scars from Binelli Lifts are a result of trying to avoid the scars of a more complete lift is needed (which can turn out quite good), and trying to accomplish too much with a Binelli lift which results in excessive tension on the wound leading to widening, pigmentation irregularities, and generally poor scarring. With a very large areola you are at even more risk for problems. Adding an implant tends to put even more tension on the scar. Also Binellin lifts tend to flatten the breast, so if your breast is already flat, the Binelli lift would not be a good choice.
Although you might prefer to avoid the scars of a lollipop or traditional lift, those might ultimately be a better choice for your situation.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.