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

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. 

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

 


 

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.

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 “stress” off the circumareolar incisions.

Best wishes

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.

As many other posters have indicated, the donut lift does not have enough internal support in your case, as is evidenced by the areolar stretching. One areola may have stretched rather than both if the internal sutures did not hold. The left has had a scar excision so there is less tissue involved right now. I do not think you can expect the areolae to even out ultimately and a revision is indicated, perhaps reoperation using an alternate technique.

Photos would be helpful in your situation. Nevertheless, there are many shortcomings with the periareolar (or Benelli) mastopexy which I rarely ever use as is evidenced by your problems. There is often too much tension on the repair, sutures may stretch or break resulting in disparity of areolar sizes or disproportionately larges ones bilaterally. Furthermore, the breast shape that is obtained is most often abnormal/far less than ideal.

You may want to consider a 2nd opinion from a reputable board certified plastic surgeon and then have a "revision" performed.

The around the nipple breast lift is very prone to relapse with stretching to the areola and recurring breast droop. The procedure has been improved with blocking sutures around the nipple to reduce the stretch and drift, though you might do better with a vertical pattern lift to reduce the tension on the nipple.
Best of luck, peterejohnsonmd.com

In a "Donut" or Periareolar (or Benelli) breast lift, there is no vertical scar to "hold" or maintain the areolar size and shape.  The only thing that allows any control over areola size and shape is a pursestring suture that closes the larger outer circle down to the size of the smaller inner circle after the skin between them has been removed.  This tightens the breast, though this is a much weaker lift than a vertical or anchor lift and is only good in cases where a minor lift is needed.  Even with a permanent pursestring suture, some stretching may occur.   With a dissolvable suture, as some surgeons use, there is a higher risk of stretching if the suture does not last long enough.  If the pursestring suture is disrupted, perhaps by additional surgery, and not replaced, then stretching may occur on that side.  And if NO pursestring suture is used at all, as with the early forms of "Donut' breast lift, the stretching of the areola occured in just about every case.