Can I Have a Donut or a Crescent Lift to Avoid Large Scars? (photo)

Hi Linita27,

    I appreciate the fact that you want to minimize scarring, but it is critical that you understand the limitation of either the donut or the crescent lift.  

     The crescent lift is performed using a partial circular incision at the top of the areola.  It is designed to elevate the nipple areola position somewhat.  In my experience, it has no place in any setting.  All it does is stretch the areola upwards somewhat with negligible lift of the breast.

     The donut lift involves an incision completely around the areola.  This lift is able to remove some skin around the areola, thereby tightening the skin envelope of the breast in a purse string fashion.  It has some capacity to raise the nipple areola complex, and can only minimally raise any of the droopy breast tissue below the inframammary fold.    In your case if you undergo this procedure, your areola would be a bit smaller, your nipple position would be raised by an inch at  the most, and only a small amount of breast tissue would be raised below your fold.  That is, you will still have a significant amount of breast tissue sitting on your rib cage below your breast fold.

     A lollipop lift involves an incision around the areola,  along with a vertical incision extending from the areola down to the breast crease.  No horizontal incision is used. This lift allows the breast to be raised quite powerfully, so that no breast tissue sits below the fold and a beautiful shape is produced.  In my experience, when this operation is done with very little skin tension, the scar usually heals quite well where it is difficult to see at the one year mark.  In my opinion, that is the lift that will give you the most elevation with the best shape. You also look like you have fair skin which should result in excellent scars.  This lift does not have the horizontal incision which on many occasions does not heal well.

     A note about using implants concurrently.  Implants have two functions.  They increase volume and affect the shape of the breast in that they produce more upper pole fullness and better cleavage.  I disagree with some of my colleagues that feel implants should not be used in lift as implants may stretch the breast even more.  I strongly disagree here.  When implants are placed behind the muscle, with appropriate muscle release, very little force is exerted by the implant on the breast tissue.

     In summary, I think you should strongly consider undergoing a lollipop lift (vertical mammaplasty).  I think an implant should be considered as well>

     Good Luck,

Ary Krau MD FACS

A donut mastopexy works very well to resuspend the breasts and reduce areolar size.  I would advocate a less aggressive lift in your particular case, including a short scar and/or donut mastopexy. 

In my opinion, a donut breast lift will not give you an ideal shape after your breast lift.  Yes there will be less scars than with other techniques but if the shape is not right, you will not be happy.  Good luck.

In the zeal to reduce the length of incisions operations have been introduced that are inadequate to deal with ptotic breasts. The picture demonstrates breasts that will not turn out well with a limited incision mastopexy.

Dear Linita

Thanks for posting your question.

Do you really need an augmentation as well as a lift? You actually have good-sized breasts, which have drooped due to stretched and thin skin. 

Whilst a breast lift will tighten and lift your breasts, an implant will only weigh them down, and put more stretch on your already stretched skin.

Personally I would recommend a lift without implants, using a lollipop scar. This will give you a great shape, a great lift, and the vertical scar of the lollipop usually fades into virtually nothing.

 

Good luck!

You could HAVE a donut or crescent lift but neither one will do you much good.  The goals of a breast lift are: 1. elevate the nipple/areola and 2. to tighten the skin below the breast.  A donut or crescent lift only performs the first goal and has VERY limited usefulness.  It is only good for elevating the nipple/areola a couple of centimeters at most and does nothing to tighten the skin below the breast.  If you are going to spend the money on a breast lift then you should do it right or not do it at all.  In my opinion you are a great candidate for a "lollipop" or vertical scar lift based on your pictures.  Anything less will save you from the vertical scar but won't give you an adequate lift. 

Hi,

Thank you for your question and photo.

Unfortunately, a crescent or a simple periareolar lift will not provide you with a satisfactory lift. Adding a large implant to 'take up the slack' doesn't work either.

In order to achieve the ideal lift, all your breast tissue must be aligned over the implant (small submuscular implant to prolong results - large/subglandular implants will restretch tissue requiring a revision sooner). 

The Mini Ultimate Breast Lift technique corrects excessive sagging by lifting and re-arranging your breast tissue to lie directly over the implant to achieve a round, perky, natural appearance without a vertical scar. The breast tissue is anchored internally by using 'straps' fashioned by your own tissue to prolong the life of your lift. Breast implants can be combined with this technique only if you desire more volume. But, if you are happy with your current size and only wish to achieve 'perkiness', implants are NOT necessary.

Look into it.

Kind regards,

Dr. H

Thanks for your question and pic. I would not recommend the donut or crescent mastopexy. The lollipop is a far better choice. Though the scar may be scary, you will get a better result and have less chance of revision. Although it seems "worse" the lollipop actually heals better because it can distribute the tension over a larger area and reduce the chance of widening of the areola that is common in donut mastopexy. Best of Luck!

Please note that none of the respondents advocate a crescent lift. I don't either. It leaves a visible scar and only a few millimeters of lift at best, or at worst, a nasty scar at the upper edge of your areola and no lift at all by a plastic surgeon who likely would have performed a periareolar augmentation incision anyway, but found a gullible patient who agreed to pay "extra" for the lift that really didn't lift at all! (Unethical).

Periareolar lifts are of limited value in certain circumstances, usually when the degree of lift needed is really borderline, when the areola is larger than desired, and/or when the degree of augmentation desired is less. Let's examine these in more detail:

First, when the degree of lift is minimal, why not simply use implants alone and see if a reasonable and acceptable aesthetic result can be achieved without a visible scar up front and visible (when nude). A lift can always be added later, and the appropriate design for the degree of lift needed can be selected, along with the attendant scars and cost. Can't go backwards if you don't like the scars.

Second, if the issue is large(r) areolas than desired, removal of some of the areola can both reduce the absolute size as well as (minimally) lift the breasts. However, the degree of true lift is limited (big circle circumference sewn to a small circle circumference always means some amount of pleating or scalloping must occur--immutable law of physics) and the scar gets worse the more you try to accomplish. BTW, how do you keep the small(er) periareolar scar form stretching? Answer: usually with a permanent suture that acts and feels like a taut purse-string within the skin. If not (or if it breaks), the areola stretches out and you end up not only with a wide ugly scar, but a stretched areola that isn't "smaller." This type of (minimal) lift also flattens the breasts.

Third, if you don't want much larger breasts, and really "need" a lift but don't "want" the scars, this is a crappy compromise (now there's a good medical term that everyone can recognize!) that solves none of the concerns, and ends up often creating a re-do surgery situation. For such an example, click on the web reference link below and see what happened to one of my patients who had a bit of post-breast-feeding asymmetry and simply wanted to be "a little perkier and back to my old size." By the time I fixed her problems, I was the third plastic surgeon performing her fourth operation! This is not a joke, and thus my recommendations that fall in line with those of the majority of my colleagues here:

Without a full examination and measurements, as well as a frank discussion regarding your goals and concerns, there is NO augmentation plus lift that does not have scars. What you really SHOULD be asking for is the best result with the least scarring possible, while realizing that the latter may indeed require a full or modified lift, expertly designed, cut, and sutured to yield pretty breasts with the desired outcome. Scars heal and fade; bad decisions and bad designs remain ever so (until the re-do surgery).

With respect, EVERYONE wants what they want without scars--you are no different. The problem is that there will always be some plastic surgeon, perhaps with lesser skills, ethics, or experience, who will offer you just what you want. (Usually under the guise of "more" experience, "new" or revolutionary technique, or higher cost--so it "must" be better.)

The "rub" is that no surgeon in existence can violate the laws of physics and scars, and the sooner patients realize that, the less trouble they cause for themselves!

You will not be happy with a crescent lift (regardless of who performs it), so leave the office of any surgeon who recommends it, and don't ask for it--someone will be more than happy to do it and let you learn the "hard way" that this does not work!

As for periareolar lifts, you may be a candidate for this operation, but only if you fit in the categories above and can see photographic evidence that the surgeon does this operation often and well. You can always add more scars and a proper lift with secondary surgery like my patient from Miami. (Click on the web reference below). Best wishes! Dr. Tholen

Hello and thanks for your post. Application of an areola lift in the face of significant sagginess will likely lead to dissatisfaction. Unless you are only looking to achieve a small or moderate, at best, increase in lift, you may not achieve the results typically desired with an anchor or vertical breast lift. Discuss your concerns with your PS and best wishes.