How do permanent sutures around the areola affect the results of a donut lift?

Dear Beautiful800656,
my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Donut lifts are notorious for flatten out the breasts because it is skin only procedure. Also, permanent sutures are used because if not then the scar will widen. An alterative is to use long lasting sutures such as PDS which will last 6 months. Unfortunately, you have not provided photographs or told us your desires. There are other lift techniques that do not require vertical scars. One of which is the mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage.

Best Wishes,

Gary Horndeski, M.D.

These are excellent and nuanced questions. Let’s break them down to help clarify how donut mastopexy (periareolar lift) and the use of permanent sutures affect breast shape and surgical outcomes, including the risk of breast flattening and scar widening.
What is a Donut Mastopexy?
A donut mastopexy (also called a Benelli or periareolar lift) involves:
• Removing a circular ring of skin around the areola
• Tightening the surrounding tissue to lift the breast
• Often includes areola reduction
It’s typically used for mild to moderate breast ptosis (sagging).
What Are Permanent Sutures Around the Areola Used For?
Permanent (non-absorbable) sutures are often placed in a purse-string (round-block) configuration under the skin around the areola. Their purposes:
• Prevent areola widening (a common long-term issue)
• Support the new areola shape over time
• Provide tension distribution, reducing the risk of wide or thickened scars
They are not always necessary, but many plastic surgeons use them proactively in donut lifts to maintain the surgical result.
Does the Donut Mastopexy Cause Breast Flattening?
Yes — flattening is a known limitation of the donut lift technique, especially when:
• Significant lift is attempted (beyond what the technique is best for)
• There is little breast volume or poor skin elasticity
The flattened appearance comes from the skin tightening primarily in the central, periareolar area, which can compress breast projection if not done carefully or without sufficient support.
Do Permanent Sutures Cause Flattening?
No — permanent sutures themselves do not cause flattening.
In fact, they are used to:
• Maintain areola shape and size
• Help reduce scar tension
• Preserve projection better by maintaining structural integrity
The flattening effect is mainly due to the donut lift technique and not the sutures. However:
• If the lift is over-aggressive, even with permanent sutures, flattening may still occur.
Can a Donut Mastopexy Be Done Without Permanent Sutures?
Yes — but there are trade-offs:
• Higher risk of areola spreading (widening) over time
• More tension on the scar, which may cause thickening or irregularity
• Less support for breast shape, possibly leading to shape distortion
Some surgeons may use long-lasting absorbable sutures instead, but they are not as durable long term.
Does a Donut Mastopexy Without Permanent Sutures Still Lead to Flattening?
Yes — the risk of flattening is inherent to the technique, not the sutures.
• Without permanent sutures, the risk of flattening and areola stretching increases, especially with poor tissue support.
• But even with permanent sutures, if too much lift is attempted or there’s not enough volume, flattening can still occur.