Breast lift around areola is a good operation with a good surgeon.
As with almost everything in plastic surgery, what matters is the skill and good eye of the surgeon, and not the name of the operation. Periareolar breast lift with areolar reduction and breast implants is a great operation if done properly.
Problems with Circumareolar Breast Lifting?
Thank you for the question.
You have described the downsides of using permanent as well as the downsides of using absorbable sutures. The best solution I believe does not involve the use of mesh. You may need the planned change to a vertical mastopexy to relieve tension around the areola area. This can only be determined upon the direct examination.
I hope this helps.
Problems with peri-areolar mastopexy
It sounds like you may need to consider a different technique, a different surgeon, or both.
In my experience, the only times I have seen problems with areolar stretching were when the patient really needed a different type of lift procedure, but had a peri-areolar lift because they wanted the smaller scar.
I always ask my patients (when I think they would be better off with a different technique)- "If your breasts look funny but you have the scar you wanted, will you be happy?"
This is no different than any other surgical procedure when placed into the proper context... There are many operations that are very effective for the problems they were designed to address, but if done on someone who really needed a different operation the outcome will not be good.
When a peri-areolar lift is done on carefully selected patients, with good technique, the problems you describe do not occur.
Periareolar or Circumareolar Mastopexy & Breast Augmentation
This operation can be done without having areolar enlargement if the right permanent suture is used and placed in the proper position. An interlocking purse-string suture and reduction to small implant should give you the result you desire. Another option would be to convert to a vertical patterned mastopexy.
Cutting away skin only won't work, that's for sure
For any plastic surgeon who does a lot of breast surgery, they will tell you that taking up the excess skin by making a tight suture around the areola only just won't work for huge areolas. The surgeon has to do SOMETHING to support the breast, whether it be mesh, lifting the breast tissue itself with an internal mastopexy, or the like.
That's why you will hear a lot of surgeons say that you should have a vertical scar, because through this method they reduce skin tension on the areolar closure. Skin should never be under tension and holding up the breast tissue; the breast should be lifted from within and there should be no tension on the skin. This being said, asking for a sizable augmentation with a lift always places the patient at high risk of areolar stretching, as this surgery naturally places the skin under tension. aka you.
Most US doctors don't use the mesh as we have heard reports of extrusion and complications. I personally separate the skin from the breast, lift the breast tissue, and them close the skin on low or no tension - at the same time reducing the areolar size. Hope this helps.
Areolar stretching after augmentation mastopexy
Unfortunately, the biggest problem we have with augmentation mastopexy is areolar stretching. The only solution is a permanent stitch but I agree the stitch may be able to be felt if not buried deep enough.
The breast lift with mesh you are referring to is a technique develped by a Brazilian plastic surgeon named Goes. He uses this mesh to envelope the breast tissue, below the skin, then support the tissue for lifting and prevent areolar stretching. Unfortunately, the mesh he uses isn't available in the U.S. but it is an interesting technique for medium sized breasts.
A periareola reduction cann only be performed in the right individual. If your areola are very large and you need a lot of skin excised to acoomodate for laxity, then you may have been better off with a formal lift. I use a gortex type suture which is very soft and I can not remember a single patient complaining about the palpability of it.
Purse String Areolar Reductions or breast lifts have these problems frequently
The smaller implants will help take the tension off, but the purse string technique is known to have all of the problems that you mentioned. The best solution would be to add the vertical scar. This will redistribute the excess skin instead of purse stringing it together.
Concentric Mastopexy+Areola Reduction+Large Implants= Lousy Combination
Great question. Your dilemma affects hundreds of women who successfully pressured their plastic surgeons to do a periareolar mastopexy when a Vertical scar mastopexy would have been the answer.
Think about it for a second - WHY would you require a permanent periareolar suture after an areolar reduction if you areola was really that large? Was it because it was either over reduced and / or stressed with an implant whose foreward pressure put constant tension on the repair ("knot could be seen and felt ").
Your "solution" - ? remove or down-size the implants to reduce the tension on the areola as logic would dictate? No. Exactly the opposite. You remove the purse suture, the only barrier to areolar stretching, reduce the areolas again (increasing the tension of closureon them) and INCREASE the subsequent stretching of the areola by putting in larger implants. How does this make any sense unless you want ever increasing complex breast reconstructions.
The mesh technique was described by the Brazilian surgeon Sampaio Goes. Through a periareolar approach, he peels the skin off the breast (like a banana) and wraps the breast with a non-FDA approved mesh (NOT found on the American Market). The mesh caged breasts are then lifted and suspended with staples to the ribs in a higher position on the chest.
Few American plastic surgeons, if any, would recommend this operation in general, much less in your case. No one would date put permanent coarse mesh around a breast (infection risk, breast cancer detection concerns, scarring etc). Peeling the skin off your breast risks losing the circulation to your nipples which may result in in dead nipples. Finally, there is no reason why it should even work.
The easiest solution is to settle for the smallest implants, if any, that would NOT put tension on the areola and STOP removing breast skin ever increasing the tension on the closure.
Concentric mastopexy variation to avoid areola stretching
Not heard, seen, or done the mesh mastopexy of the areolars. I would be very careful with this technique. Sounds too good to be true.