What Causes Overstretched Areolas and How to Prevent Them when Getting Breast Implants if One Has Small Areolas?

Hello, I am wondering what causes areolas to be over stretched after breast surgery and what are some precautions to take to prevent them from overstretching like in the first photo? Below are two photos I am sharing of two patients who started out as an A cup.

Doctor Answers 23

Several Factors are Associated with Areola Stretching - Read them Here

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Minimal stretching of the areolas probably occurs to some degree in the majority of breast augmentation patients. This stretching in the presence of enlarged breasts following breast augmentation may not even be noticed by the average patient. However, in some cases this stretching can be significant and extremely bothersome to patients.

Several factors are associated with areola stretching. These include large implant size, sub glandular implant position, and poor patient skin tone. When large implants are used in a sub glandular position stretching of the areola is more likely. The elasticity of the patient’s skin is also important. Patients with poor elasticity are more likely to have stretching of their areolas. Also when patients undergo simultaneous breast lift procedures, stretching of the areola is more likely as well.

The best way to avoid areola stretching is to avoid these risk factors. Whenever possible smaller implants placed in a submuscular position should be utilized.

If you’re concerned about this issue consultation with a board certified plastic surgeon is appropriate. This surgeon should be able to make an appropriate recommendation. 

Areolae strecthing with breast implants

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The areolae will always stretch or widen to some degree after breast implants. As the skin stretches to accommodate the increased volume so does the areolae since it is part of the overall breast mound. 

How much the areolae will stretch or widen depends on several factors including the patient’s native elasticity, the size or volume of the implant, the placement of implant, and if being done in conjunction with a breast lift or not. I have never seen a technique or personally performed a technique that does not have some degree of areolae stretch when adding volume to the breast. It may be minimal or extreme but it always happens. It is just part of the procedure.


Mark A. Jabor, MD
El Paso Plastic Surgeon

Overstretched Areolas with Breast Implants

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There is a dynamic relationship between; the hard tissues of the chest, (sternum, ribcage), the soft tissue, (breasts), and the implant.  A breast augmentation augments, (enlarges), the breast tissue.  What you have on your breasts, (freckles, areola), may appear to be larger when done.  This is usually in proportion to the amount of stretch that you put on the tissue.  Sometimes the areaolas can get larger than one would expect.  Implants that are too large for the skin, subcutaneous implants, poor skin coverage, genetic skin laxity are some examples that may predispose some to large areola.  Best to have a consult with your board certified plastic surgeon.  Bring photos of what you desire.  Together you can make a plan that hopefully will avoid an outcome that you don't want.

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

It's Tough to Prevent Areolar Stretching But I Have Little Tricks

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Thank you for your question. This is a tough one, as with breast augmentation, you are indeed stretching the areola by construction. There are some little tricks, particularly a suture technique that I can perform, that can help minimize stretching of the nipple areolar complex.

Note that in the second photo, the woman's areolas did not stretch largely because the implants are placed significantly too low. She has a result that we surgeons colloquially call "star gazing", where the nipples point upwards. (This is something I very much try to prevent when performing breast augmentation.)

Stretching areolas from implants

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You should expect some degree of stretching with implants, and it is more noticeable the bigger your implants are. This is because the implants stretch out the skin of your breast, which also affects your areaolas. If you want to minimize stretching, it's recommended that you stick with smaller, proportionate implants.

Ronald Levine, MD
Toronto Plastic Surgeon
4.6 out of 5 stars 25 reviews

How to keep aureolas from stretching with implants

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The larger the implant, the larger the areolar will expand. Draw  circle on a balloon and blow it up. The circle will enlarge directly proportional to the amount of air in the balloon. This is a perfect analogy. If you have small areolar and want to keep them relatively small, be conservative with the implant size. Thank you for this interesting question.

Wide areolae after breast augmentation

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Permanent stitches can be used to help prevent widening of the areolae after an augmentation.  However, despite this they still may stretch out.

Areolar size and augmentation.

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The final "stretch" of the areola depends upon the pre-augmentation size of the areola, the size of the implants placed, the elasticity of the tissues, and whether implant sizes were increased via one operative or over several reaugmentations. Areolar stretching is typically not a big concern as the increase in size is minimal. However, for women who have had larger breasts (typically following pregnancy) followed by some involution, stretching of the areolas can be significant. Many times, this second group of patients require a breast lift with their augmentation. Both of the women in the photos have over-sized implants. Choosing an implant that is smaller in size and projection will also put less stretch on the breast skin and areola.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Enlarged areola can get stretched even further with large implants.

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When the skin is stretched from large implants, sometimes the areola can stretch and enlarge too.  One way to prevent this is to use a circumareolar permanent pinwheel suture that keeps the areola at a fixed diameter.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews


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Basically the less breast tissue you have and the larger the implant size will create more stretching of the skin and areola.  If you would like to minimize areola stretching go with a smaller breast implant that fits best with your dimensions.

Todd B. Koch, MD
Buffalo Plastic Surgeon
4.6 out of 5 stars 37 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.