Based on your photos, it looks as if you could have benefited from a vertical lift. Your implant is placing strain in your nipple and stretching it out.
Dr. Sheila Nazarian
@drsheilanazarian on Instagram
The best way to reduce the size of your nipple and to reduce the risk of it widening is twofold:
#1–it is not so much the material of the stitch but the way it is placed. A purse-string suture around the nipple can help reduce the nipple spread but even better than this is the interlocking stitch described by Dr. Hammond. This specific type of wagon wheel stitching makes it even less likely that the nipple spread with the tension from the skin removal.
#2–avoid a crescent lift. Instead, a circumareolar is better, and even better than that is the lollipop incision. The lollipop incision will allow some of the tension to be shared by the "lollipop stick". This way less tension is placed around the nipple and it is less likely to spread. As a benefit it will allow a better shape for the breast. It will make it more rounded natural.
There is a lot of nunace in these maneuvers. I recommend you see an experienced board-certified plastic surgeon. And, I wish you luck!
Periareola breast lift
To reshape your areola you need at least a periareola lift not a crescent lift. However, I would also recommend you consider a vertical lift which will take the tension off your nipple areola area and make your central breast less flat, more conical. The down side is the vertical scar, but it might be well worth itin the long run for a better aerola and breast shape. Discuss with your surgeon.If you choose periareola, Gortex is a good option. Good luck.
Although a permanent Goretex suture may limit scar widening, I have been disappointed with it allowing scar widening and dilation of the areola in the past. Have you investigated using Embrace, a post operative scar control product. This could be applied two weeks after scar revision. It would not have an effect on the widening of the areola.
PTFE sutures are not the answer
PTFE or Goretex sutures can be used when completing a donut or circumareolar mastopexy. The sutures can be placed either as just a pursestring or as a wagon-wheel blocking suture to help prevent scar widening. But in your case, the problem is the thin skin more than it is the wrong kind of suture being used. You could dramatically improve the appearance of your areola and breast, but it would require a big change for you. I would suggest changing your implant to a smaller one, placing it under the muscle, and then completing a vertical breast lift that involved using a vertical scar in addition to the one around the areola. The scars will be much better and the areola will be much more stable and normal in appearance.
The use of PTFE sutures can retain the areolar shape when a mastopexy or an areolar is performed.
Not only are PTFE sutures helpful in preventing scar widening in circumareoalar breast augmentations but also getting the tension correct such that the tissue inside the circle is of proper tension to "pull back" against the forces tending to undue the circular suture. The negative effect of this circular tension is a flat breast that is heay on the bottom because no forces are place to push the breast back up. You may benefit next time by have a vertica lift done which would address both problems. Good luck.
Would PTFE help?
Many surgeons use PTFE suture with this technique but not all. Scar and areolar widening are an inherent risk of this procedure whether you use the suture or not, though using it does appear to reduce this risk. I would discuss your concerns with your surgeon.I hope this helps.
PTFE suture and stretching?
Hi Jayced. I appreciate your question and I'm sorry to hear about your breast surgery experience. I use the PTFE suture when I perform areola lift and reduction, but not all plastic surgeons use it. I see that it works to limit areola stretch in most patients, but with bigger implants there is more stretch and even the suture cannot overcome nature. This suture technique cannot be used with a crescent lift. It can only be used by going around the areola all the way (peri-areolar). Since it's been 11 years since your first breast surgery, you should probably consider getting an entire revision surgery with implant exchange and placement of the breast implant below the muscle. Silicone sheeting works for flattening the scar and not so much for reducing stretch in the areola. Best wishes always, Dr. ALDO