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

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.)

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. 

The added volume of a breast implant stretches the entire skin envelope including the areola.  If you wish to prevent areola stretching, an incisions made around the areola and a purse string suture will prevent the areola from changing size and allows the patient to select their desired size.  The photograph shown on the left have larger areolas and would benefit from a reduction.  The photograph shown on the right have too small areolas.

Best of Luck,

Gary Horndeski, M.D.