A lift with an implant is controversial for two reasons. First, when you perform a lift you are making everything tight and closing the wounds under tension. It you add the expansive forces of the implant at the same time, you are fighting against yourself. There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars. In the worst case, the wounds will open. So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant. Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure. Or a smaller implant than would be appropriate is used so as to decrease the expansive forces. Either way, you are compromising the aesthetic outcome. Often the outcome is so compromised that a second revision surgery is required. If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation. The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved.
The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple). By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple. By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple. If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop. If the venous outflow stops, the arterial inflow is stopped. If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies.
Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation. Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.
You can have both procedures done during your breast augmentation but the results may not be as predictable since your breasts will undergo changes over the following 3-4 months.
Breast Augmentation with Nipple/Areola Reduction
You are right, a breast augmentation will increase the diameter of your areolae and since you feel your areolae are already large, you may very well want to consider having them reduced at the same time as your implant surgery. When I combine these procedures I use a separate incision in the fold underneath the breast for placement of the implants in order to minimize the risk of nipple numbness, infection and capsular contracture.
Would you suggest an areola and nipple reduction?
A breast augmentation with areola reduction is possible and will provide some lift to the breast which you may need. Understand that there is a slight increase in the chance of capsular contracture when a areolar incisions are used.
Areola and nipple reduction
Hi and thanks for your question and posted photos. If you want to get your nipple and areola smaller and breast augmentation yes, they can be done at the same time. The most probable is that your areolas will be wider after some time with implants. Be sure to see a board certified plastic surgeon.Best wishes.
Thank you for your question. Based on your photos you appear to be an excellent candidate for a breast augmentation procedure to produce beautiful results. If a nipple reduction is another procedure you wish to have done , yes those procedures can be combined to produce excellent results in patients. The best advice is to schedule a consultation with a board certified plastic surgeon to be further evaluated. During your consult you can discuss your surgical options, address your goals and work together to create a surgical plan that will best help you achieve the overall look you desire.
With kind regards,
Lane F. Smith, M.D., F.A.A.C.S., F.A.O.H.N.S., F.A.B.F.P.R.S.
Las Vegas Plastic Surgeon
Will augmentation will stretch out the nipple even more.
If you review many breast augmentation photos you will see that for most the areola will become slightly larger with the pressure of the breast implant. There are two approaches, you can have an areolar reduction at the time of the augmentation, or you can delay until after your augmentation. Why delay? The less pull on the scar the more potential for better healing.
Matopexy helps to reposition the nipple and reduce the areola creating a more full upper breast to give a lift as well as areola size decrease similar to a breast reduction, but with only skin excision, no breast tissue. The nipple is always attached and maintains sensitivity and function.
Would you suggest an areola and nipple reduction?
Yes, it is fine to do a nipple and areola reduction at the time of the breast augmentation. Unless the implants are oversize there is no appreciable increase in areola diameter with breast augmentation.
Breast enhancement surgery
When we talk about breast enhancement surgery, it is not just about placing implants to make the breasts bigger. It is also about changing the shape of the breast/areola/nipple, if needed, and addressing breast asymmetry. Every breast procedure performed is customized to each particular individual based on their anatomy, desires, scars and the skill and expertise of the surgeon.In this situation, the left breast is slightly larger than the right in volume and the nipple position is lower (more ptosis). There is a slightly tubular shape of the breasts with a little elevation of the inframammary crease. The diameter of the areola is just slightly larger than the average. The chest circumference is wide and there is a lack of upper pole fullness, but the breasts are close together in the midline.I would perform an asymmetric concentric mastopexy/augmentation with saline or silicone implants (preferably silicone) to reduce the areola size and place the nipples on the same horizontal plane. The implants could be placed above or below the muscle, the size to be determined at the time of the consultation. The nipples can also be reduced at the same time, if desired, in height and diameter if needed. The scar would be around the entire areola, but permanent purse string suturing should prevent excessive or wide scaring, no matter what size implant is placed.Please see a Board Certified Plastic Surgeon with expertise in breast enhancement surgery to obtain the best possible results.Good Luck!