How to smooth persistent Breast Lift wrinkles around the areolas
I completely agree with Dr. Zubowicz. The most heavily abused operation in Breast Lift surgery is the periareolar ("donut", or around the areola) Breast Lift. Unfortunately, the operation is really useful in cases of minimal breast sagging.
As you know, the normal youthful areola diameter is about 4 cm. Unfortunately, it gets stretched out with age and pregnancy. In a periareolar breast lift, a cookie cutter is used to mark a 4cm areola and then an outer circle is drawn around the areola once temporary stitches have "lifted" the breast to its new position. the stitches are then removed and the intervening breast skin is then removed leaving a donut gap which is closed by bringing the WIDER outer circle to the narrower periphery of the new areola. The problem is that in so doing there is buckling and cinching of the outer breast skin just as are seen when the string of a lawn bag is pulled. Although there is some smoothing of such irregularities, often they are permanent, especially in a Breast Lift in which a Lollipop incision should have been used.
The only way to smooth the area is to remove the pleated scar, open the incision and remove the excess skin below the nipple complex with a vertical scar as should have been done during the original operation.
Dr. Peter Aldea
Pleating of skin around areola after donut mastopexy
This sometimes happens after a donut mastopexy. In a donut mastopexy, a larger circumference of skin has to be closed around the smaller circumference of the areola. The larger circumference of skin has to be "pleated" to make it the same size as the circumference of the areoala. In order to avoid this, as your surgeon explained, you would have needed to add a vertical scar on the breast, which you did not want. It is possible you could have a scar revision to improve this but would have to accept a vertical scar.
Hope this helps.
The suture may be the cause
If your plastic surgeon used a permanent suture around your areola to keep it smaller, this can sometimes cause "pleating" like a drawstring effect. This suture can be removed if it was used and although your areola may become a little larger, the pleating should soften a lot. Best of luck.
Updated May 13th:
You almost certainly have a permanent peri-areolar suture to hold your areola to a given size. I always place the knot for my peri-areolar sutures at the 12 o'clock position in the event that I am asked to remove them. Realize that if the suture is removed it should make the puckering better but your areola may stretch wider. Talk with your plastic surgeon and he/she can give you their advice of your concerns. I hope this helps. By the way, this suture should be able to be removed under local anesthesia and does not commonly require a trip to the operating room.
Additional surgery/revision likely needed.
Wrinkling can occasionally occur
around the circumference of periareolar mastopexies.After 18 months, this probably won’t improve
without additional surgery.
This problem occurs when surgeons, and patients, attempt
to limit the scarring that occurs with breast lift surgery by performing
periareolar mastopexies.In some cases,
there’s just too much excess skin for the operation to be successful.Under these circumstances, the discrepancy
between the areola and the resected skin border is too great to bridge without
a gathering suture.To avoid spread of
the scars, a permanent suture is utilized.
Correction of this problem requires conversion to a
classic mastopexy with an anchor-type incision or lollipop incision.Revision will require release of the
permanent sutures around the areola and removal of excess skin below the
areola.This technique is usually
associated with excellent clinical results and high levels of patient
If you’re considering correction of this problem,
consultation with a board certified plastic surgeon with experience in this
area is appropriate.This surgeon should
be able to formulate a treatment plan that addresses your anatomic findings and
achieves your aesthetic goals.
Breast scars and areolar scars can be treated with laser
The areolar breast scars can be tightened with a laser skin resurfacing and laser treatment that can improve redness, complexion, and skin wrinkling. Check to see if this is available in Lebanon.
Areolar wrinkling after donut lift
This result is a classic example of a donut lift used to remove too much sagging tissue, creating puckering around the nipple-areolar complex. A scar revision might slightly improve the situation but the only way to fully correct it would be to perform a secondary mastopexy using another technique. If the purse string sutures are removed or relaxed to reduce the wrinkling, sagging will ensue.
Periareolar folds and wrinkles after Benelli lift
This is really one of the big draw backs of periareolar techniques. You can expect continued settling and improvement but also will likely have continued spreading. This is why your surgeon like most plastic and reconstructive surgeons prefer to use these techniques in cases of minimal ptosis. At some point if there is recurrent ptosis, converting to a vertical lift with a 'lollipop' scar can be helpful.
All the best,
Rian A. Maercks M.D.
Donut mastopexy is an overused operation and correction of wrinkling requires a more formal mastopexy.
The only way to fix your scars is to elevate and advance the skin of your breasts towards the areola. This will require at least a vertical scar and possible a small extension in the inframmary crease. Donut mastopexy is seldom indicated unless the breast is "tubular".
The Benelli (aka "Donut") Mastopexy has limited applications
This type of wrinkling is fairly common following a Benelli/circumareolar type mastopexy. Although many patients do not wish to have additional scars on their breasts, frequently it is the only way to obtain a "perky" shape. If the wrinkles that you are experiencing do not resolve over 6-12 months (and they likely may not), then your best option is to have your breast lift converted to different type that will remove more skin.
Depending on the surgical technique that was used, it is possible that you may have a small amount of wrinkling around the areolar scar. This commonly resolves with time and massage. However, if after 18 months you continue to have significant wrinkling, it is possible to correct this with a number of techniques. If you only have one area that has wrinkling you may consider an injection of a small amount of corticosteroid to this region. If you have wrinkling around the entire areola or uneven wrinkling, you may benefit from opening the incision and helping redistribute the skin around the areola and then subsequently closing it.