Do I need a breast lift? If so, what type of incision? (Photo)

I want to reduce my areola's, and I don't want the lollipop scar. Which would be best for me...over the muscle or under the muscle?

Doctor Answers 10

Limited Lift and implants

Your right and left profile photos document that you have "pseudoptosis" (fake droopiness), where the NAC, nipple areolar complex is at the same level as the IMC, inframammary fold, hence you may be eligible for a short scar lift technique, (doughnut or periareolar technique).  The dual plane (partial subpectoral muscle/partial subglandular) would be ideal to safeguard against overloading your breast skin brassiere, which has already been stretched out (by pregnancy, weight fluctuations?).  Here's an innovation: consider using an anatomical, textured cohesive gel implant, inserted via the inframammary fold, in order to ensure correct positioning and downsize the NAC, separately.  In my practice, the "gummy bear gel" implants are useful for the following cases: 1. desire a "natural" (non heaving) upper pole (area between the collar bone and nipple); 2. need stability of positioning to recruit (stretch) lower pole (area between the NAC and IMC); 3. choosing a breast implant-lift; 4. do not object to a firmer breast; 5. desire an implant, which is less likely to reoperation because of rupture.  Do interview several practices, ask about their experience and review their photos.  Good luck. 

Orange County Plastic Surgeon
4.8 out of 5 stars 56 reviews

Do I need a breast lift? If so, what type of incision?

You need a breast augmentation/lift. You have depleted upper poles of the breasts and would get a nice improvement with submuscular implants. The type of lift you need is dependent on the physical examination. Are you OK with trading poor shape over minimal scars? A Benelli or periareolar lift might work to reduce the areolar size, but does not lift sagging breast tissue. I, personally, would do a vertical or lollipop incison to give you the best shape to your breasts. See a board certified plastic surgeon for an in person consultation/evaluation. Good luck.

The Perfect Breast

You would definitely benefit from a breast lift, which reduces the skin envelope while reshaping the breast tissue into a more youthful and perky shape. Sometimes implants can also be added for more volume, but this increases the complexity of the operation and recovery and so must be done by someone with a lot of experience.

During any breast lift we place internal sutures to reshape breast tissue. In a vertical (lollipop) lift we are able to perform a more powerful reshaping of breast tissue due to our ability to reduce the skin envelope as well. The trade off is the extra incisions and scarring. Here is the breakdown for your decision making in breast lift surgery:

Breast Augmentation - increases volume, superior pole fullness, and has scarring in fold beneath breast
Vertical Breast Lift - Excellent repositioning of breast tissue with scarring around areola.
Lollipop (periareolar, donut) breast lift - Improved position of nipple and moderate reshaping of tissue.

What type of breast lift?

I believe you would benefit from an augmentation/mastopexy.  The implants will provide some volume in the upper pole of the breasts.  The lift will reduce the size of the areola, reposition the nipple and provide contouring of the loose skin.

A donut lift (circumareolar or Benelli) can limit the amount of scars but is also limited in the amount of lift and shaping you can get.  It is a good procedure in the right patient.

A lollipop lift (circumvertical) has a vertical scar below the nipple but allows for a greater degree of lift and shaping.  This is also a very good procedure in the right patient. 

It all boils down to your individual anatomy and your overall goals.  If you insist on limited scars, you may limit your overall results but it is a personal preference.  I recommend you meet with some board-certified plastic surgeons in your area and discuss your options in person.  Best of luck! 

Jeff T. Healy, MD
Oahu Island Plastic Surgeon
5.0 out of 5 stars 95 reviews

Do I need a breast lift?

Your breasts would look better with a mastopexy (breast lift) and augmentation.  There are pros and cons to the different techniques to which you refer.  You should consult with a board certified plastic surgeon who can examine you and discuss the options for both procedures, and their respective pros and cons.

David S. Chang, MD
San Francisco Plastic Surgeon
5.0 out of 5 stars 4 reviews

Seek consultation

Given your current state of loss of volume and very large areolas, you should seek a consultation in person from a board certified plastic surgeon to determine if  a circumareolar (doughnut) lift will be adequate. If you require lifting the nipples 2cm or more, a doughnut lift may stretch and elongate your areolas over time. Partial submuscular implants would give you the best look with the least chance of hardening of your implants over time.

Wesley G. Schooler, MD
Santa Barbara Plastic Surgeon
4.8 out of 5 stars 17 reviews

Do I need a breast lift? If so, what type of incision?

From your photos, you are correct, you will require a breast lift along with a breast augmentation.  If you would like to avoid the vertical scar associated with a lollipop mastopexy, you may be a good candidate for a donut (Benelli) type of mastopexy, in which the only incision is around the areola.  With this type of lift it is possible to reduce the size of the areolas to some extent.  Depending on the size and type of implant you choose, the implant could be placed either above or below the muscle.  Each position have it's relative advantages and disadvantages. Seek out a board certified plastic surgeon in your area with extensive breast lift and breast augmentation experience.  Best wishes, Dr. Lepore.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.9 out of 5 stars 50 reviews

Do I Need A Breast Lift & If So, What Type Of Incision?

Your breasts are hanging on your chest wall, your areola are too large and too low on the breast mound, and you have no fullness in the upper quadrant.  Yours is the classic situation requiring a breast lift with a breast augmentation.

If you were my patient, I would put the breast implant below the muscle and do a Benelli mastopexy which will lift the breast up, lift the nipple up, and reduce the size of the areola all at the same time without giving you a vertical scar.

Do I need a breast lift? If so, what type of incision?

While I can understand your reservations about the vertical scar, I have found that trying to avoid the scar when necessary is counterproductive.

Kenneth Hughes, MD

Los Angeles, CA

Is Breast Lift Needed?

Consult with a board-certified plastic surgeon, since there are too many factors to consider to be able to make a recommendation based on photos. 

The link below is a case that might be similar to you. She had a breast augmentation with a donut mastopexy.

All the best.

Heather J. Furnas, MD
Santa Rosa Plastic Surgeon
4.8 out of 5 stars 28 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.