Areola Reduction With Scarring- Revision?

Circumareolar incisions always leave visible scars, some good, and others bad. The amount of length discrepancy between the outer incision (and its larger circumference) and the inner incision (with its smaller circumference) directly impacts the degree of scalloping and irregularity in the closure and the final scar quality. Add to that the fact that living skin stretches as it heals, and you have the result your photograph shows.

Use of a permanent Goretex "blocking" suture (soft, and minimally stretchy) will decrease the tendency for periareolar scars to stretch and widen over time, but you can also expect some degree of areolar or breast flattening from this type of (minimal) "lift."

Other kinds of breast lifting may be recommended to decrease the degree and/or severity of sagging or "snoopy-dog" deformity, ranging from crescent lift (worthless, IMHO), to repeat periareolar lift (you've seen how that works out; why I'm not a big fan), to vertical lift (for an example, click on the link below), to full Wise pattern (anchor) lift with the attendant scars. You probably don't need the full lift based on your present appearance, so I'd recommend the periareolar scar revision with Goretex "blocking" suture at this point in time. All the other options remain available to you if you wish, and as time goes by. Good luck!

Hi,

Unfortunately, because of the weight of your implants, your areolas will inevitably stretch. I like using a special suture that minimizes the stretching. This seems to help a great deal. Scarring depends on two things. Your body's ability to heal and technique of your plastic surgeon. Hope this helps.

Overexposed flash photo hides your issues, please re post a better photo. Revision can be done using better sutures and suturing techniques. 

You indicated that you had a breast augmentation and areolar reduction but was the latter part of an attempt to lift up droopy breasts? Are your implants above or below the muscle? Is there drooping still present right now?

These are some of the questions that would need to be answered in order to provide you with the most appropriate recommendations and prognosis for outcome - short and longer term. The short, general answer is that an areolar reduction can clearly be performed to reduce the size. The durability of effect would be dependent on the surgical technique and sutures used as well as implant size and location above versus below the muscle.

If you presently also have drooping which you seemed to intimate from your question, then the areolar reduction would need to be part of some sort of lifting procedure that involves more extensive incisions. You would be best served by obtaining consultations from 2 or more reputable board certified plastic surgeons in your area and assessing their recommendations

Not knowing what you started with or exactly what was done at surgery it is impossible to say what should be done now. What you are asking for may not be possible with your current breast implant size, you may have to downsize them. The most important thing you can do is get copies of your records including before surgery pictures and operative reports so that prospective surgeons can look at them and then give you relevant recommendations on how to proceed forward.

Donut removals of skin around the areola are notorious for stretching out the areola when the donut of skin is too large. It should be obvious that if you do another donut removal of skin you will end up with an even worse result. Just cutting out the scar and closing it is a donut shaped removal of skin and so would be inadequate.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

When you review photos, before and after breast augmentation you will notice universally that the areola will enlarge due to the increased breast size and pressure of the implant. Areolar reduction at the time of augmentation can be difficult as the reduction is fighting the pressure of the implant and relapse is common. A 'blocking' suture can be helpful to get the nipple down to the 4cm you wish and will resist relapse. Also a vertical lift pattern will resist relapse, though at the cost of the vertical scar.

Best of luck,

peterejohnsonmd

Most likely the size and weight of your implants have caused your areola to widen. One option is to remove your current implants and down size to smaller implants which place less stretch on the areola. During the same surgery, a revision of your areola size could be performed. Using a gortex suture around the areola will also help to less the chance of widening of the areola in the future.

One other issue to consider, is that fact that these large implants have stretched the breast tissue and skin. If you down size your breast implants, you may be left with ptotic or "drooping" breasts due to the excess breast skin. The may require a mastopexy or "breast lift" to reshape your breasts. This unfortunately would leave additional scars on your breast. It is important to seek the advice of an experience plastic surgeon to help you with this.

Good Luck