I want breast implants, but not scars from a lift, would larger implants & areola reduction be enough? (Photos)

Question

After breastfeeding 5 children for 10 consecutive years, now I have moderate ptosis with enlarged areolas. I want implants & an areola reduction. Could getting larger implants & an areola reduction be enough to forgo a breast lift? I love the look of a lift, but hate the look of the scar, & I tend to scar easily. What would it look like with implants & no lift?

Gerald Minniti, MD, FACS · Answer

The worst of all breast lifts, the crescent lift should be abolished. It only functions to elongate and enlarge the areola. The only valid periareolar lift is the circumareolar lift, aka 'Benelli' or 'donut' lift. Hmm, another pastry! Anyway, if both breasts looked like your less ptotic one, the donut lift might be valid. Unfortunately, your other breast is lower, and applying the donut lift to that one and expecting it to look like the other is a fantasy. Any surgeon trying to get symmetry will cause a whole host of problems too: circumareolar pleating, thick scars, re-expanded and irregularly shaped areola, and a flattened breast mound appearance. Also, be careful with implants that are bigger than you want to achieve your desired body proportions for the express purpose of 'lifting' your breasts; you'll just be back in the operating room sooner or later getting them reduced, and then with no alternative other than a true breast lift.  BTW, how you scar elsewhere on your body is no indication of how you might scar on your breasts, a relatively forgiving area.

Bora Ok, MD · Answer

Hi from Istanbul, thanks for your question. Based on your photos, it looks like you would need about a 3 cm lift. Since there is some excess skin both horizontally and vertically, the best results in your case would likely come from an anchor lift with a short horizontal scar, combined with round implants. This approach would help achieve the look you're aiming for while addressing your concerns. Hope this helps.

Leila Kasrai, MD, FRCSC · Answer

Implants need to be centred behind the nipples regardless of their size. Therefore, your implants would sit rather low on your chest without a lift.

Christopher V. Pelletiere, MD · Answer

Based on your pictures, you should be able to do a breast augmentation with a breast lift around the areola only ("donut" lift).  That would provide better symmetry between each side in terms of nipple position.  It appears that one breast is larger than the other as well, so using different sized implants may be needed as well.  The best thing to do is to have a consultation with a board-certified plastic surgeon and see what is recommended.  I hope this helps.

Gianfranco Frojo, MD · Answer

You will need a breast lift with an anchor type scar pattern to obtain any adequate long-lasting results. Areolar reduction surgery alone with an implant will create a very widened and flattened looking nipple-areola complex.

Nicholas Wingate, MD · Answer

Hi Creative, 
Thanks for your good question which has gotten some varied responses. I think this shows that there are different approaches. The one that is right for you is one that you have discussed with a board-certified plastic surgeon who has given you appropriate expectations of what the different procedures will entail. If increased volume and limited scars are the biggest priority, an implant alone will likely get you where you need to be. If scarring is a major concern I would advise against any areolar reduction. Long term the areolar scars are often the most noticable even in the best surgeon's hands. 
Scars from various versions of a lift are very managable and typically very well tolerated. So if your surgeon truly recommends a lift based on their exam and your desires, this is something to seriously consider. 
Best, 
Nicholas Wingate, MD, ASPS Member, Board Certified Plastic Surgeon

Keshav Magge, MD · Answer

Thanks for your question. Based on your photos- I think a full beat lift with implants would be the best option.  Otherwise the implants would be higher, and the tissue would sag down over the implant.  The areola could be made smaller at the same time. No one loves the vertical scar but it does fade over time. All the best.

Jonathan Heistein, MD · Answer

Hi.  You don't need to have a breast lift.  If you don't have the lift, you will still have a natural shape and some sagging, but this is definitely ok.  Don't expect the implants to provide the lift, and if you go too big, then they won't look very natural.  The lift would give you a more youthful look with less sagging, but you would have more scars. 
Instead you can have a partial lift and areola reduction with a scar around your areola only.  This might be the best of both worlds for you.  Talk to your surgeon about this option and the other options so you can make an informed decision about what will be the best for you.

Daniel Barrett, MD · Answer

Dear Creative7107,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Matthew C. Camp, MD · Answer

If you scar easily, I would suggest just an implant to correct the deflated breast shape. You look to have a distance from fold to nipple that is within the range of normal. You could have an areolar reduction, but I don’t think the payoff would be worth the scar.  I think an implant alone will serve you well. Seek out a board certified plastic surgeon, and look at their before and after results.

I want breast implants, but not scars from a lift, would larger implants & areola reduction be enough? (Photos)

Answers (19)

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