Areola Reduction with No Skin Excision--periareolar Subcuticular Purse String Suture? (photo)

Your picture suggest slight enlargement of your areolas in
the absence of significant breast sag.Unfortunately, your arms are elevated in this picture which may cause
the extent of your breast sag to be underestimated.For this reason, a physical examination would
be helpful.In general
terms, periareolar mastopexies usually require a skin resection.When a purse string is performed around the
areola without an adjacent tissue resection, the areola tends to be puffy and
protuberant. It doesn’t lie flat if there’s not an associated partial areola
resection.Furthermore,
scarring is variable with periareolar mastopexies.Scarring occurs when wounds are closed under
tension. This is more likely when the procedure is used to provide lifting of
the breasts and discrepancies exist between the length of the opposing wound
margins.For
these reasons, it’s important to realize that areolar reduction and periareolar
mastopexy may involve significant tradeoffs.In some cases, the scarring associated with this procedure may be worse
than the slightly enlarged areolas that concern you.Under
these circumstances, it’s appropriate to proceed with caution.Make sure you consult a board certified
plastic surgeon and get all your questions answered. Remember that once you
have scarring in this location it can be hard to treat.

Patients often ask me if their areolas will appear larger after breast augmentation.The areola will measure larger but the proportion of your areola to breast will not change. Based on your photos, I agree with your surgeon that you do not appear to need a breast lift.  The areola can be made smaller by excising a portion of it or by placing a purse string suture.  In my experience, doing both gives the most long lasting result.  Remember, by increasing the size of your implant from 300cc to 425-475cc will also make your areola appear larger.

I think the key is to figure what you are willing to accept in term of scars. You have a great shape and the size is very nice so going up to 425-475 may overload your tissue and frame. An areola reduction with permanent suture as Dr Repta discussed so well is the procedure of choice. Good luck and please update us on your decision and results. Please see a board certified plastic surgeon.

Hi gms123, Disharmony between the areola size compared to the breast itself is a common issue. Areola reductions are a common request with and without lifts. I do not personally feel the scarring is that significant. You essentially have a new outer line around your areola and for the first year it may be a bit more apparent. Skin is going to be excised no matter what, without the lift, it will just be a smaller amount of areolar skin. I would recommend meeting with at least one other board certified plastic surgeon to get another opinion on this. Going up in implant size also changes the game. They need to see you in person and do an exam with measurements to give an accurate recommendation. Good luck!

and I personally agree with your surgeon that you should not do anything.  This is not a perfect world and your areolas are more generous than you desire.  But would you like it better if you had a smaller areola with a horrendous scar around them?   My patients would not like that. 

If you do see other doctors and they promise they can achieve what you desire, I caution you and ask that you understand their revision policy should things not work out as you desire so you are not left 'holding the bag' in the end and worse off then what you started with.

Yes you could have a donut mastopexy/arealor reduction but since want to go bigger it may limit the size of your new implants but a periareolar reduction wiuth a purstring is fine.

Areolar reduction is almost always done with skin excision as the standard. The scars are usually an acceptable trade off for the improvement. I would ask your surgeon to show you some photos of average scars after a per--areolar lift so that you can get an idea of what to expect, though scars are different on each patient. Then you can make a reasonably educated choice as to whether the scar is worth it for the expected size reduction. 

Sometimes it is possible to make a number of stab incisions around the areola to place the permanent purse-string suture, but you would need quite a few of these, and I am not sure that the smaller intermittent scars would be better than the standard incisions.

Thanks for the question, and best wishes.

I perform circumareola suture placement for the situation you describe and for small areola lifts all the time. you should go for a consultation.

By the definition of the purse string operation we are removing areolar skin! So a scar could occur. Best you seek in person evaluations to fully understand this technique. 

Areolar sub-cuticular sutures can be use in selected cases but are not very effective 

You could reduce the size of your areolae without a lift or even excising skin. but it will involve a scar around the areolae

These scars usually heal very well