I'm 32 and I have 36 DD breasts with rather considerable sag. Donut lift with large breasts? (photos)

Dear Kind966616,
my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Your breasts are likely too large and ptotic (droopy) to have a good result from a periareolar procedure. You will need excess skin removed to improve the overall shape of your breasts with any considerable reliability. While scarring is always a concern, letting your surgeon know up front that you scar poorly can help, as he or she will likely be diligent with things like scar cream, silicone sheeting, steroid injections, and PDL lasers. It is always a difficult decision to proceed with a T scar (wise pattern) incision on patients that have a history of poor scarring, however I would not choose a procedure that would give you inappropriate results just to avoid a scar.

You are a great candidate for a full mastopexy or breast lift/reduction. You will have nothing but problems and zero result with a periareolar or donut lift. With a mastopexy, you will have the standard "anchor scars", but you will also have a significant, durable result with reshaping and better proportion. You need to weigh your priorities and benefits vs scars, but I would not hesitate to recommend for rejuvenation of your breasts. See link for an example much like your situation. Thank you.

You have a grade 3 ptosis and a donut mastopexy would be a poor choice to elevate your nipple/areola to the correct position and to tighten your skin. Donut mastopexies also have a high incident of the areola enlarging again due to traction from the surrounding tissues. Your best result would come from an anchor incision to elevate your nipple/areola to the correct position, to resect some excess skin from the lower portion of your breast and a reliable reduction of your areola. Immediately postoperatively, you could begin some silicone sheeting to give you the best scar quality possible. Have a detailed consultation with your plastic surgeon regarding this. Best wishes.

The periareolar mastopexy, or donut lift, is a great procedure when patients are selected appropriately. A successful result often requires the use of implants and breasts that are not too droopy. Based on the photos you provided, your best chance for a successful lift is not with a donut lift, but rather an anchor or lollipop lift. These options will allow for more effective reshaping and lifting of your breast tissue to achieve an ideal result. If you have a history of poor scarring, be sure to discuss this with your surgeon and show them examples of your past scars.

Dr. B.

I would recommend the Wise pattern lift (anchor) in your case. A periareolar (donut) lift would put too much tension on the areolar closure leading to wide scars and widened areolas. The scar can be quite acceptable since there should not be excessive tension on the closure with a Wise pattern.

The technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. The size of the areolas can be reduced to the size you desire.

Best Wishes,

Gary Horndeski, M.D.

Excellent question, while many women would prefer to avoid the additional scars from a lollipop or anchor lift, the indications for a donut lift alone are very limited. In your case there is too much excess skin and the nipples are far too low to be able to correct the appearance with just a periareolar lift. You would end up with very wide and hypertrophic scars around the areolae due to the significant tension that would be required. A lollipop lift would be necessary to get you a good result. There are options for managing scars that you can discuss with your surgeon to minimize the chance of hypertrophic scars afterwards but a donut lift alone would give you a horrible result.

No, a doughnut lift will not be enough lift and may just wind up flattening your breasts. I would suggest the vertical lift. Scar treatment can begin once the tapes or stitches are removed and can be done for the next 6 months.

From the photos you are not a candidate for the donut lift due to the degree of ptosis. A standard lift would be recommended for the best results. You would not need a reduction unless you want one. Something to consider is autoaugmentation. This uses your own tissue to provide more upper pole fullness. This is not a fat transfer. I've included a video that I hope you find helpful.