Areola reduction: risks? worth it? (Photo)

Breast revision surgery next month. I currently have 16 yr old Mentor Saline 270 overfilled to 300cc, under's, very firm and dropped w/ rippling. My doctor suggested Classic Mentor silicone 340cc under's, fuller (cleavage) but still natural look. I am also considering an areola reduction. Should I be concerned about ugly scaring around my nipples? How can I prevent this? Should I reconsider? 5' 9" 135 lbs / athlete / very private

Doctor Answers 10

A lift would be better

From your photographs, in my opinion, to create a more youthful breast would necessitate lifting your breast up on the chest wall which would include making the areola smaller. When properly done, and the vast majority of patients, there is an imperceptible scar, that in the patient's mind is well worth the result. It's a trade-off. Best of luck.


Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Areola reduction: risks? worth it?

Yes, these are important decisions for you to make, as as physicians we feel it important to inform our patients of options along with the positives and negatives of each but to also help guide them in the direction we feel will give them the best chance to achieve their goal based on our experience. Unfortunately for patients on this site, you will contact doctors with a wide range of experience and thus often widely differing advice. Having cared for patients with your concerns for over 30 years my advice would match your surgeon's in that we prefer silicone submuscular (but dual plane) implant placement. The standard Mentors are very nice but for a patient with a high risk of rippling I prefer the Inamed Inspira prosthesis. A well done areola reduction can look quite good with only a fine line scar but must be done with a permanent suture and the wagon wheel style closure for satisfactory results, Best of Luck.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Goals vs Scars

There always is a balance between your goals and what you are willing to go for (scars) to find the optimal treatment(s).

I agree with below that an areolar reduction will make your areola smaller but will not only produce a scar it will have a flattening effect on your breasts.

I would also ask about Natrelle Inspira breast implants which will help you reduce wrinkling as well.

Best Wishes,

Nana Mizuguchi, MD

Nana N. Mizuguchi, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 45 reviews

Consider Mastopexy

Thanks for the great question and the photos. In my opinion I don't know that you would be happy with just a areolar reduction. I suspect your surgeon is wanting to do a peri-areolar mastopexy. Looking at your photos, it appears as though you have a fair amount of sagging of you breast tissue. Increasing the size of your implants will not address that extra skin laxity you have. 

When it comes to scars, it's always a trade off. Your trading more scars for a better breast shape. Doing a reduction around the nipple only typically leaves bad scars. By having a breast lift you will get a better shape to the breast with better healed scars in the long run. Ask your surgeon if this is an option. Best of luck

~Dr. Sieber

Areola reduction is not worth the risks

in my opinion unless you have monstrous areolas which you do not.  However, you do have some mild ptosis and if you are considering a lift with your procedure, your areola will be reduced then.  If a mastopexy if added, avoid the Benelli technique and that is notorious for poor scarring and unpredictable long term results in addition to flattening of your projection.  To me, that 3 strikes!  But if you want smaller areola, then you will need to accept the risks for scarring.  Gel implants will help with diminishing rippling and will change temperature more slowly, often reflecting what the ambient temperature is.  As for highly cohesive gel implants, they will create excessive fullness on top, unless that is that is what you want... but they aren't supposed to ripple.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Revision Augmentation Mastopexy

Hello,

If you have very firm implants, you'll need to have a capsulectomy, possibly a total removal of internal scar tissue. In addition, your breasts are too saggy for a circumareolar reduction; it may lead to recurrent areolar enlargement, thickened scars, pleating around the areola, and a flattened and persistently sagging breast mound.  However, a formal breast lift will give you great improvement to breast mound shape, nipple position, and an areolar reduction. Go visit a few ABPS certified/ASAPS member surgeons that specialize in revision breast surgery of all types, not just implants. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Areolar Reduction Worth It?

To answer your specific question regarding areolar reduction I would say no as the risks (adverse scarring, flattening of your breast) do not outweigh the benefit of some modest areolar reduction. 


Based on your photos I have some additional questions regarding your planned surgery. Your situation is actually quite common with old saline implants that have gone south over time. I would guess that they also drop off toward your armpit when you lay down. You have a significant degree of sagging of your breast, and that doesn't seem as though it's being addressed - unless the proposed areolar reduction was suggested for some lifting purposes. If so, it is not an effective way to lift your breast and would accomplish little in that regard. 


You appear to relatively thin tissues which would be a contributing factor to the issues if firm feeling implant and rippling. Although you describe your implant as being very firm, I would very highly doubt that you have capsular contracture. If you did, you would not see visible rippling. Your implants feel firm because they are overfilled.


It appears from your photos that is primarily the effect of the weight and firmness of the saline implant which is dragging your breast downwards. In your post there is no indication of how or even if this is going to be addressed. Just replacing your saline implant with larger silicone gel implant is not going fix your problem of sagging and over time will only make it worse. It also won't necessarily give you more cleavage. The appearance of cleavage has at least as much to do with implant position as it does with implant size or profile. 


Also you are not replacing your implant with the latest generation of highly cohesive silicone gel implants, so you are likely to get little benefit in terms of reduced rippling. Also a larger implant will only further thin your tissues which will predispose you to more rippling. So I guess I have, in short, been critical of every aspect of your planned surgery. I'm sorry about that, but I doubt you will get the benefits that you are looking for. I would approach your situation in very different way.


First of all you need a repositioning of your implant to higher location. This would be accomplished with some suture tightening of the pocket along with internal thermal tightening of the capsule to move the implant upwards and inwards. I would replace your saline implant with a new generation highly cohesive gel implant to truly get the most benefit of reduction in rippling. The tightening and thickening of the implant pocket will also go a long way towards reducing your rippling. I prefer to use Sientra implants because they have the most cohesive gel which also very soft and natural feeling. With your implants in higher position you will achieve more cleavage without without having to go to a larger implant and thus avoid further thinning of your tissues. I think it would be useful to have a discussion with your surgeon to make sure that your concerns will truly be addressed by the proposed surgery.



Skip the areolar reduction

If you are adverse to a scar, skip the areolar reduction especially since it has very little potential gain for you. Your photos suggest that if you want a lift at all, only a full lift will be useful for improved shape and elevation of the breast. But this has more scars than just an areolar reduction which will leave you flat and baggy looking.

Consequently, I'd suggest doing nothing until you can accept a full lift.

Areolar Reduction

Thank you for adding your photo, that is helpful.  Your breasts look very natural now although they do hang a little more than some women like.  The things to know about an areolar reduction include:

  • Scars.  You will have scars around the nipple and although your skin looks like you should make reasonable scars, there is never any guarantee.
  • Numbness.  Areolar reduction can cause nerve injury resulting in permanent numbness to your nipple and areola.

It sounds like you have some capsule contracture if your implants are firm and you may want to consider a textured gummy bear implant to try to prevent recurrence of this problem.  I have added a video about these implants for you.

I hope that helps.

Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 56 reviews

Areolar reduction - is that the right approach?

Thank you for asking about your breast augmentation revision.

  • Looking at your photos, you seem to need a breast lift and possibly internal support such as ADM or vicryl mesh to support your implants.
  • This should reduce or get rid of the rippling.
  • It seems that the implants have stretched your breasts and simply changed to gel under the muscle is unlikely to fix the problem.
  • Although no one wants scars, a well-done breast lift will look better than just an areolar reduction.
  • Since the implants are firm, they presumably have a capsule around them so new implants and a new position is a good plan.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.