After a Donut Cut Lift, Why Does One Areola Get Larger and the Other Remain the Same?

Question

I had a breast lift w implants a year ago.Then I got the ugliest round raised scars which i had doctor cut out ,and then used silicone patches to reduce scarring,then right side was sagging more than the other so he went in again and recut the areola to match the left,then the left got encapsulated and he went in left side to cut away scar tissue,The right areola is streching and the left isnt,why does this happen and will the left ever catch up or will the right keep getting bigger?

Vishnu Rumalla, MD · Answer

Sorry you are unhappy.  Without pictures it is hard to comment fairly about the overall result and your expectations.  That being said, I am very selective with who is a candidate for a donut mastopexy in my practice.  If a person has poor scarring the past, I avoid the technique. In addtion, I will only perform if 1-2 cm of lifting is required.  Any greater than that leads to great stretching on the areola.  Also, did your surgeon use a permanent suture for the purse-string?  If he/she did not and a great amount of skin was removed, then stretching of the areola is definitely possible and probably expected.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Unfortunately, your experience is not unusual. Circumareolar mastopexy is a very limited operation with a relatively high rate of problems associated with abnormal scarring, areola asymmetry and the need for further surgery.  Although the use of permanent sutures may be helpful in preventing spreading of the areola,  the sutures also have their own share of problems.

	In person examination may be helpful;  it may be that conversion to a vertical mastopexy is necessary to relieve the &ldquo;stress&rdquo; off the circumareolar incisions.

	Best wishes

Jed H. Horowitz, MD, FACS · Answer

There are a number of issues here:

	
		unequal amounts of skin removal create different amounts of tension on the scar
	
		the scar size can be controlled by using permanent sutures
	
		a better lift and scar control can be done with a lollipop or vertical lift
	
		anchors lifts are old school and not needed
	
		benelli lifts are not the same as a donut

Rian A. Maercks, MD · Answer

This is the most common problem with periareolar lifts.  i generally use apurse-string suture on the outside circle of breast skin combined with four nipple spanning mattress sutures to provide lasting support and have obtained nice results.  It is very difficult to control the aging of these techniques and depending on your breast shape it might be helpful to convert to a vertical pattern that is able to provide support.

	 

	 

	All the best,

	 

	Rian A Maercks M.D.

Steven Wallach, MD · Answer

Soudns like you have had some problems. The areola can stretch differently for each side after a donut type procedure. I try to minimize the difference by placing a permanent suture inside as I am sewing to minimize the stretch.

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