Areola discoloration 14 months post-op, is this normal? Will they go back? (Photos)

This is not the normal or expected result. It looks like you had compromised healing which resulted in the jagged red scar under your areola, possibly due to a high tension closure. At this point you could seek the opinion of a board certified plastic surgeon with experience in breast lifts, and see what can be done. Best wishes on a happy final result

Dr Camp

You could try some non ablative erbium laser like Palomar Lux 1540 to try to stimulate some collagen and improve appearance. I would be inclined to start over, revise all the incisions now that there is not as much tension on the incision line as there was at the time of the initial closure. Then use the laser preventively, along with embrace scar therapy to unload tension on the healing incision/scar.

You have some hypertrophic scarring around your nipples that may be amenable to scar revision. Hypertrophic scars can often also soften and lighten with time. Massage and silicon gel or taping may help expedite things. The loss of coloration in the nipples may continue to improve with time although once it is stabilized for several months you are likely nearing your end result. One option for correction is touchup nipple tattooing. Practices specializing in breast reconstruction often have very talented tattoo artists available. Reach out to such a practice in your community and see what options are available.

Hello,
Thank you for sharing your concern.
At over a year post-surgery, it's expected that scars begin to fade and mature; however, persistent redness may suggest delayed healing, hypertrophic scarring, or residual inflammation, which can vary by skin type and individual healing response. Changes in areolar pigmentation—such as lightening or loss of pigment—can occasionally occur due to reduced blood supply, trauma from surgery, or post-inflammatory hypopigmentation. In some cases, pigment may gradually return over time, but this is not guaranteed. A clinical evaluation by a board-certified plastic surgeon or dermatologist is recommended to assess scar maturity and pigment changes and to discuss potential treatments such as scar therapy, microneedling, or medical tattooing if needed.

Scars can evolve for the better part of a year post op.

At 2 months, it is entirely too premature to pass judgement on scarring. Scars fade and soften over time.

Patience is likely the most crucial ingredient in any scar management regimen. Scar creams can help. Silicone sheeting has also proven effective in managing scars.

If the primary concern is the hyperemia or redness of the scars, IPL or other energy based therapies may be of some assistance.

For areolar depigmentation, tattoo remains a standard of care.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

You don't suffer full or actual vitiligo (an auto inmune disease discolouring skin of people), but many patients with scars around the areola (breast augmentation, lift, reduction, biopsies, etc), when they are terribly phobic before surgery, with panics and extreme stress, frequently develop an hypopigmentation interestingly sourced at the scar, it is like the scar "eats" the melanine of the adjacent areola.

Nothing to worry about, this is what happens due to over strees in surgery (and worse things may occur); I did not see any case of spontaneous reversal of melanine loss, the advice is a micropigmentation with an experienced areola tattoo master.

Hello, thank you for the photos and question. I know changes like this can be concerning, especially so long after surgery. Scar redness can still be normal as scar redness can persist for 12–18 months or more depending on, skin tone, scar care, genetics and sun exposure. There are things you can do to help minimize or fade them such as, silicone gels/sheets, gentle massage, avoiding sun (or using SPF), and time. Loss of pigment can happen after some surgeries due to disruption to blood supply, healing trauma, and scarring underneath. Will the pigment return is the question and the answer to that is possibly, especially if it's due to temporary damage or healing or if it's been stable or slowly worsening over months, full return is less likely without treatment.

Your scars are a red and wide and appear thick. The areola appears to have lost pigment where it was under more tension and is not round. Tattoo can help or maybe more time. Your surgeon should have recs for you. I would consider scar revision in OR for the best result which may improve nipple position and areola size and symmetry. Good Luck!

An unwanted type of scar formation can occur when the scar loses pigment and becomes lighter in color. This may happen due to circulatory issues, suture reactions, or infections during the healing process. It’s an undesirable outcome, and unfortunately, it cannot be reversed completely.
However, the visibility of the scar can be reduced through a scar revision procedure. This is the only effective way to improve its appearance if such discoloration or textural changes develop.

Based off your photos - (no preop photos for comparison) - its difficult to say how this exactly happened but can happen post mastopexy (breast lift). It seems to have happened on both sides as well - sometimes while healing that area has more to heal since its on the bottom of the breast as well as at the junction of multiple incisions (can lead to more scar tissue, decreased blood supply etc) - which can lead to de-pigmentation over time from loss of pigmented cells (melanin cells). Usually if you are this far out and its still light, likely not going to return back to the original color. If there's loss of sensitivity there (which can happen as well) you might want to try skin tattooing for more color (the tattoo artist these days are very good at matching to the correct shade). Also, revisit with your surgeon and see some possibilities of what can be done and / or what caused this.

Thank you for sharing your photo — it provides helpful context. At 14 months post-op, it's reasonable to expect scars to be settling and fading, but what you're describing suggests a few things worth considering.
Persistent redness in scars can occur, especially in individuals with fair or sensitive skin, or those prone to hypertrophic scarring. While some redness at this stage can still fade with time, if it’s been stable or worsening, treatments like laser therapy, microneedling, or topical silicone may help.
Loss of pigment on the areola (hypopigmentation) is not uncommon after procedures involving periareolar incisions. It can result from:
Disruption of melanocytes (pigment-producing cells) during surgery
Scar tension or inflammation interfering with pigment distribution
Reduced blood supply in certain areas during healing
Unfortunately, hypopigmentation may not always fully reverse on its own. In some cases, the pigment gradually returns over time, but if it does not, medical tattooing (micropigmentation) is a commonly used and effective option to restore natural color to the areola.
It’s best to have the area evaluated by your surgeon or a provider familiar with post-surgical areolar changes to determine whether pigment recovery is still possible or if a corrective procedure may be helpful.
I hope this offers some clarity and reassurance as you navigate next steps.
— Güray Yeşiladalı, MD