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

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 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.

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.

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

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.

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.

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.

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.

Breast augmentation involves increasing the volume within a specific breast skin envelope. Small breasts can have either large or small areolas, and everything in between. Depending on how much small breasts are enlarged (the size of the implants), the areolae will stretch to some degree. The amount of stretch also depends on implant placement (either above or below the muscle), the thickness of the muscle (if below), and the patient's own weight (thickness of subcutaneous fat layer). Even breasts that start out reasonably large will show some degree of areolar stretch if the breasts are enlarged further!

Another major factor is whether or not the woman was previously obese and lost weight (such as gastric bypass patients), or had babies and breast fed, losing breast volume while having had previously-stretched areolas. Re-filling a "deflated" skin brassiere will certainly enlarge a contracted areola.

Plastic surgeons know this because we (at one time in our training or experience) create skin grafts. When we cut out a circle of skin, the donor site stretches, and the graft contracts. This is because skin is elastic. Thus, a smaller less-stretched-out breast will require some skin stretch (including the areola) if the volume it encloses is increased (or if a fixed volume is kept within a tightened--lifted--skin envelope). Some may have just forgotten this.

Your first photo example underwent periareolar (Benelli) skin tightening, and appears to have unnaturally-large anatomic implants (or capsular contracture causing firm distorted breasts). It is impossible to ascertain what her areolas might have looked like prior to her augmentation because of the periareolar scars.

The second example is both disproportionately large and over-augmented (except for a porn star) and "bottomed out" with nipple/areola complexes that are too high on her breast mounds, but still quite small in diameter. I would suspect that she had inordinately small areolas prior to her augmentation, but can confidently assure you that they did indeed stretch some!

If you click on the link below, my website shows 31 breast augmentation patients (before and after photos) in our practice, each of which provides age, implant size, and often how many children each has had. You can clearly see that anyone who says that areolas "don't stretch" is basically not checking their patients very closely, or has forgotten their training, since virtually every augmentation patients show some degree of areolar enlargement as their breasts are enlarged. Of course, some stretch more, and some less, but to say that it doesn't occur is inaccurate.

You can also see that the smaller pre-op areolas appear darker than the stretched post-op areolas. This is another physiologic fact we learn from our skin graft training (and something we employ when performing areola reconstruction after mastectomy). The reason this happens is that same number of pigment cells is present in the areola before and after augmentation (assuming no surgery on the areola, just implant placement), but when you have the same number over a larger (stretched) area, the pigmentation is less dense and appears lighter. You can see this is the patient photos where the pre and post-op color matching is good. This is another "proof" of areolar stretch.

Age, weight, previous weight, pregnancy status, breast-feeding status, previous breast size, implant size, implant position, and genetics all play a role in determining just how much an individual patient's areolas will stretch. This is too many variables to make an honest and accurate prediction, but areola stretch will always occur! There is no technique that can prevent this, nor will submuscular placement eliminate stretch from occurring. Best wishes!