Can an areola reduction tighten breast skin?

Question

I had a breast explant two weeks ago, have larger areolas (about 6cm stretched) and some loose skin. My areola fall right at the breast line unless constricted then they're about 1 cm above the crease. I don't think I even have enough breast tissue for a full lift, I'm wondering if an areola reduction alone will lift the nipple and tighten the skin?

Anthony Deboni, MD · Answer

Thank you for your question. Is difficult to make any assessments without a photo. In general however, a periareolr breast lift, or "doughnut mastopexy" has relatively little lifting power. It can reduce the areolar size modestly, and provide a small amount of lift, but rarely does it result in significant elevation of the breast tissue. Similarly, it is not a good idea to try to remove too much skin around nipples with this technique, as it can result in rippling and pleating of the skin. Mastopexy involves removing varying amounts of skin in order to reshape and elevate the breast. Options include a peri-areolar(doughnut), vertical (lollipop), and inverted T( anchor). Which operation is best depends on a variety of factors including breast size, degree of ptosis(droop), areolar size, skin laxity and patient desires.

With a periareolar mastopexy, skin is removed from around the nipple only. This is helpful in reducing the nipple/areolar diameter and can give a small amount of elevation.  This results in a scar just around the nipple. It is important to realize that this procedure generally provides only minimal lift. It is generally best for patients with only minor ptosis, and those who want to decrease areolar size. It is many times performed in conjunction with an breast augmentation.

A vertical mastopexy requires both an incision around the nipple and down vertically to the inframammary fold, hence the term “lollipop.” Sometimes the incision is extended laterally to create more lift.  This is a much more powerful operation in achieving lift and change in breast shape, as it allows more skin to be removed, and more control over the breast shape.

The most aggressive mastopexy is an inverted T, which is sometimes called and anchor lift, or a Wise pattern lift.  When compared to a vertical mastopexy, this adds a scar along the inframmammry fold. This type of lift may be needed when the patient has significant droop and skin excess. It can significantly  lift and change breast shape, but it comes at the cost of a longer scar.

When meeting with a patient for a mastopexy consult, the surgeon will perform a thorough evaluation of the breast, looking at the amount of skin excess, skin quality, degree of ptosis, and nipple areolar diameter. In conjunction with the patient, a recommendation will be made.  It is important to note that the amount of lift that can be achieved is generally directly related to the amount of scar; if a patient has significant skin excess, a periarolar mastopexy will not be appropriate, and a more aggressive lift may be required.

I spend a great deal of time discussing the resultant scars with the patient.  In my experience, most patents are willing to accept a longer scar for improved shape. If the patient requires a more aggressive lift, but are not comfortable with the scars, it is better to not to perform surgery than try to do a lesser operation.In summary, only an in person evaluation will likely give you the answer to your question.  Best Regards.

Camille Cash, MD · Answer

By reducing the areola the breast skin is tightened somewhat.  The determination needs to be made if that is an adequate lift for you.  An examination is needed in order to decide that.  I encourage you to meet with a board certified plastic surgeon in your area for a consultation and discussion of your surgical goals.

Steven Wallach, MD · Answer

In some cases reducing the areola size will be enough, but you would have to be seen in person to be sure. Best of luck.

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