Candidate for Donut or Crescent Lift? (photo)

Question

Hello, I am 29 years old, 5'2" and 32D from Canada, seeking a breast lift, NO augmentation. Photos attached. Distance from neck to nipple is 22cm ish. I've lost about 20 pounds over the years and, growing up, I think I was not wearing a nearly supportive-enough bra. I have loose skin above the nipple and stretchmarks. Like everyone else, I want minimal scarring and am wondering if I would be a good candidate for the donut or cresent lift. Also, best solutions for stretchmarks? Thank you

Gary M. Horndeski, MD · Answer

Dear Baffled,

	Thank you for your question and photos.

	You seem to be an ideal candidate for the Mini Ultimate Breast Lift. The Mini UBL does not require a vertical scar to successfully lift and move breast tissue (in your case, moving it towards the breast bone). This is achieved by a series of internal straps fashioned from your own tissue to permanently secure your tissue and prolong the life of your lift. Your only incision is that of a circumareolar incision. A crescent or donut mastopexy can only remove excess skin and move the nipple/areola complex.

	Hope this helps.

	Kind regards,

	Dr. H

S. Larry Schlesinger, MD, FACS · Answer

Without doing a face to face evaluation and more measurements, it is hard to give you an absolute answer. I do not recommend a crescent lift as your areolar are already large, and a crescent lift would only make your areolar larger and not give you very much lift. A standard mastopexy with an anchor scar would certainly get your breasts in the appropriate position, but it might be more surgery than you really want to go through.

If by the term donut mastopexy, you are referring to a circumferential or Benelli mastopexy, I think this is a reasonable alternative which will leave minimal scarring and will correct some, but not all, of your droop (ptosis).

If by the term donut mastopexy, you are referring to a circumferential or Benelli mastopexy, I think this is a reasonable alternative which will leave minimal scarring and will correct some, but not all, of your droop (ptosis).

Jed H. Horowitz, MD, FACS · Answer

Most commonly, we prefer
the lollipop or donut lift because of the shape, small scars and easier
healing. Removing a donut shaped
piece of areola and skin then using a #Pursestring or double purse-string
suture to tighten the skin, there is no need to add augmentation, but a tighter more youthful look will be attained. The crescent lift also removes a small amount of skin at the top of
the areola. We find that there is very little 
lift and the areola becomes oval in shape and distorted with this method. So, it appears that both methods would be an option, but likely the donut lift would be better.

Joel Patrick Maier, MD · Answer

First off, a crescent lift is
worthless, a sham lift, don't do it. If you go to a surgeon with experience
with a periareolar lift, then you could get some benefit. But know the
limitations including flattening of the breast, minimal to moderate lifting and
a puckered look around the areola due to pleating of the skin gathered around
the nipple. A vertical, or lollipop lift will result in a more fundamentally
sound lift with better shape (more projection and narrow shaping of the
breast), a more crisp and round areola as the stress of the lift lies on the
vertical scar. The downside is the vertical scar, which will be visible,
permanent and can take up to a year to mature.

While I can see the merit in avoiding an implant, IMHO, doing either lift
without an appropriately sized implant would result in only mild rejuvenation
of the breasts, so you may want to consider all options.

Raffy Karamanoukian, MD, FACS · Answer

A donut mastopexy may provide you with a subtle lift coupled with a reduction in areolar diameter.  This may be particularly suitable in your case. Raffy Karamanoukian Los Angeles

Marc Pacifico, MD, FRCS(Plast) · Answer

Dear Baffled One

	 

	Breast lifts are, like so many operations, a compromise - the less scarring you have, you compromise on shape; whilst if you are prepared for more scars, the shape of your breast will be optimised.

	That said, looking at your photos, you would be a candidate for either a circumareolar (doughnut) mastopexy or a circumvertical mastopexy (with the additional vertical scar going down from the nipple to the breast crease.

	What I said above applies with both these options. The more powerful and longer lasting of the two is the circumvertical, but you have to accept the additional scar. This scar fades with time and, in my opinion, is worth the trade.

	Regarding your stretch marks, these are a result of a breakdown of collagen links within the skin (the building blocks of the skin structure), so no cream or laser is going to remove these. Unfortunately there is no reliably good treatment available for them (despite what many claim!)

	Good luck with your decision, and I hope this helps

Gregory T. Lynam, MD · Answer

You appear to have some asymmetry and if you want smaller areola size I would perform a vertical mastopexy. No good treatment for stretch marks uless they are red then laser can remove the redness. Good luck and please see a board certified plastic surgeon.

Steven M. Lynch, MD · Answer

Hi.....I think you would be a candidate for the donut pexy but you would need to have areola spreading explained to you. Often when we are trying to minimize scarring with the donut pexy, there can be a spreading of the areolas and it can be disturbing. I show patients pictures of this spreading to make sure that they can accept it. With the lolipop or anchor pexy, the 6 oclock position "locks" the circle around the areola and this minimizes the chance for the spreading. If you can accept that vertical scar with your very light skin, then I think you would be better served to do a lolipop pexy or at least let your surgeon know that if they see it is necessary at the table, then they would have the option of making that decision. If you cannot accept it, then do the donut and see how you like it. You can always convert it later if you are not happy.

Jourdan Gottlieb, MD · Answer

Thank you for your question and the attached photos.

	If you are content with your current breast size, there is no reason that she shouldn't expect a nice improvement with a doughnut mastopexy. This works well when the nipple and areola don't have to be moved very far and when there is not a large amount of skin excess. 

	The crescent lift but probably not do enough of a lift. In addition I find patients are generally last pleased with an incision part way around the areola and one all the way around.

	Best wishes.

Tom J. Pousti, MD · Answer

Thank you for the question in pictures.

	Although you may be an excellent candidate for circumareolar breast lifting surgery, whether you should undergo the operation or not will depend on your specific goals. I would suggest that you meet with well experienced board-certified plastic surgeons to discuss these goals, surgical options, as well as a potential risks/complications associated with each option.  Make sure you consider the presence of scars,  the potential abnormal scarring, areolar spreading, areola asymmetry…as you make your decisions.  Personally, ( generally speaking) I do not recommend the “crescent” breast lift,  because of the high incidence of unsatisfactory  outcomes.

	I hope this helps.

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