I had my breast done approx three years ago and got an areola reduction at the same time. The breast augmentation came out nice, but the areola reduction left me with an ugly scar. When I went back to the plastic surgeon to discuss this issue he told me that the scar was gonna get better with time and all i need is to tattoo the areola and it will be fine. Is this true? Should my plastic surgeon do a scar revision to make my areola look "normal"?
Areola Reduction Scar? (photo)
Doctor Answers 4
Should the areola be reduced at the time of a breast augmentation?
When the areola is large, often from stretching with pregnancy, it can be reduced surgically to be smaller. The scars can be around the areola only or like a lollipop ( around the areola and then a line from the areola to the crease under the breast. When the breast is lifted, the skin is made smaller. When impants are used, the breasts are made larger. Trying to make the breasts smaller and larger at the same time can be tricky. If the skin is too tight, the scars can have difficulty healing.
So, can the areola be reduced at the time of an augmentation? Yes, but be careful or the scars could be tough.
Enlarged Areolar Scars
Areolar reduction scars notoriously have a tendency to heal poorly. The areola always "remembers" its original size, plus any breast size increase will place tension forces on the closure. Scars of this nature tend to widen, be highly conspicuous, and the areola enlarges and flattens along with it. Permanent suture material is commonly used to close these incisions as a "purse-string", cinching down the outer original areolar diameter to a smaller size. Regardless, the tension forces often win the strength of the suture material. The treatment would require scar revision, and I usually add a skin take-out or dart vertically down from the bottom of the areola to decrease the outer areolar diameter, removing the strain from the circumareolar incision. In this case, you would need the addition of a new scar going down the lower central part of the breast, however, the areolar scar would look much better and the vertical limb scar tends to heal and fade very well over time. If you did not have a permanent purse string suture placed in the first place, and your surgeon only used absorbable sutures in the closure, another option would be to revise the areolar scar with different suture material and hope for a better outcome, but there may be a high risk of recurrence. It makes no sense to do a scar revision alone, and expect a different outcome because of the inherent tension forces in the breast are still there. A change would need to made. I personally feel it is worth the trade-off of an additional scar on the breast to make the areola smaller and have a tension-free closure on the areola so the scar around it is inconspicuous.
Areola Reduction Scar? TATOO IT OR REVISE THE SCAR
Areola scarring post reductions can be problematic. Depending on the quality of the patients skin (elasticity, age, thickness, fibrous structure) the scars can stretch even with the most exacting closures. This can also happen because the actual breast tissue is not supported and can stretch much like in pregnancy. I have found that the two options my patients seem to prefer is to have the color of any scar blended between the areola and the surrounding breast skin. The scar can also be revised, but it can just stretch out again with very little net improvement.
I have had success converting a concentric mastopexy (shown in your photograph) to a vertical or full anchor-pattern mastopexy, where the actual breast tissue can be coned upon itself to get more collagen support and coning of the breast tissue.
Sometimes the simplest solution is finding a skilled cosmetic tattoo artist and having the scar blended!
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I agree with Dr. Brown's assessment. To summarize, your problem could have been due to a number of things that we don't know at this time:
1. Areolar reduction was too large, and you really needed a vertical mastopexy.
2. No permanent purse string was placed at the time of reduction, and the forces spread your areolae unopposed.
3. None of the above, but you had substantial spreading scars anyway.
I don't agree with your ps. That scar will not look good tattooed. In addition, your areola still looks very large, and is sitting low on your breast, indicating that perhaps it was not the right type of lift/areolar reduction for you initially. I think you would be best served to get in person second opinions from a few surgeons that specialize in revision surgery and are capable of performing complex lifts and reductions.
Best of luck!
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