Areola "purse string" lift or NO? See my pics and let me know if this PS is making a mistake on me. (photos)

A “purse-string” mastopexy works  well as long as the nipple does not have to be elevated more than 1-2 cm. and as long as there is not a lot of excess skin. If either of these are the case I would recommend a different type of mastopexy. Based on your photos (and not knowing what your breast measurements are), you may not get the results you are looking for with a purse-string mastopexy. I would also recommend that you speak to your surgeon about the placement of your implants if you are concerned about that. With an experienced, board-certified plastic surgeon, your scars should fade to a thin white line and become very unnoticeable over time. Good luck with your decision.

I've never been a big fan of a purse string mastopexy.  The purse string mastopexy has very strict criteria for use and I just don't find many patients that satisfy the criteria.  The amount of skin to be removed from your picture is generous.  I find the results look more like tightening the string on a duffle bag and it fails to make the breast tissue into a desirable cone shape.  Also a better picture, than the one you have which is fairly soon after her procedure, would be a picture 6 to 8 months out.  I find the nipple tends to get wider and the scarring can be wider also. A wise-pattern mastopexy works very well to improve the shape of the breast.  The way I explaining a breast augmentation with a lift procedure to a patient is that I am simply putting a new larger base under the breast shape you bring to the table.  It is best to shoot for a breast shape on top of the implant with a more cone shape that one that looks like a duffle bag.

Your surgeon showed you some nice results, but I think they had less need for correction that your situation.  If larger amounts of skin are removed with the circumareolar incision, the risks of wide scars, large areolas, and pleating as well as suboptimal shape are significant.  You need to get a balanced view of not only good results, but what the potential downsides are. With a vertical incision, there is much more control of the shape, a submuscular position can be used, and the width of the scars, and the size of the areola can easily be controlled.

Based solely on your photos, I think you are going to be happier with your results if you go with a vertical lift. I would definitely get a second in person opinion.My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

not my choice from your pictures due to the amount of breast skin droop or ptosis.  Be careful, it is tougher to go backwards.  Find someone you are comfortable.

Personally, I'd suggest a short vertical (lollipop) approach. The key to an aesthetic breast is proper shape and contour. The purse string lift will leave you with a boxy breast and flat in the front. 

For better or worse, there are many potentially 'correct' techniques for a lift - this represents some variability in what different surgeons think they can accomplish with a given technique; one is not necessarily 'right' or 'wrong.' I would go with the surgeon you felt you had the best rapport with and understood your goals best. I hope this helps.

I think that the amount of periaerolar skin that is being proposed to be removed is pushing it and with your skin type you will likely get an unattractive scar.  That is why others are suggesting a vertical incision, since the scar won't be so bunched up (though longer.)  I would not recommend a subglandular approach for fear of worsening shape, in the long run.

The around the nipple breast lift has been around a very long time, first called a donut breast lift. The Benelli purse string is meant to reduce the main problem, areolar stretch and relapse. The more skin taken with this technique, the greater the risk of a poor scar and relapse and therefore most are cautious and when photos look as yours do we consider the vertical or T pattern. We have not examined you, though if you feel uncertain you might step back and get another opinion.

I would go with the original 2 opinions you got. It would appear that your 3rd docs photos are 1) on the table and 2) very early. If you only want a 3 month result, you could consider a purse string. The late results in someone presenting like you would be undesirable. The bottom will drop out and you will need a revision at your cost.