High areola after breast reduction

Question

6 years ago I got a breast reduction. After surgery I immediately noticed that my areola were too high and on my left breast I lost a bit of my areola due to necrosis. Since then I've been way to nervous and scared to get another surgery to try and fix them because I don't want the same thing to happen and my breast to look even worse. I've gotten a few consultations for a lift to try and correct the areola placement and to cut out the necrotic piece of areola. Is this my best option?

Krishna Vyas, MD, PhD, MHS · Answer

It sounds like you’ve been through a difficult experience with your breast reduction, and it's understandable that you're nervous about further surgery. Given that you have concerns about the high position of your areolas and the necrosis on your left breast, seeking additional consultations from experienced plastic surgeons is a wise approach. Many surgeons can offer solutions like resizing the areolas, addressing the necrotic tissue, and adjusting the height of the areolas by performing a breast lift, which can help reposition the breast mound and the nipple. Surgical intervention may be necessary to achieve the desired outcome, and it's essential to discuss your options with multiple experts to find the best plan for your situation.

Dr. Krishna Vyas, MD, PhD, MHS
Harvard, Johns Hopkins, & Mayo Clinic Educated
Double Fellowship Trained
Aesthetic Plastic Surgeon
New York, New York

Dr. Krishna Vyas, MD, PhD, MHS
Harvard, Johns Hopkins, & Mayo Clinic Educated
Double Fellowship Trained 
Aesthetic Plastic Surgeon
New York, New York

Joshua T Halka, MD · Answer

I would recommend getting a few opinions from different plastic surgeons for how you could best tackle this problem. You could definitely have the areolas re-sized and have the area which was necrotic addressed, and it may be possible to adjust the height of the nipples on the breast mound. Having a breast lift to change the shape of the breast mound, and therefore where the nipple sits on the mound may be your best option.

John Michael Thomassen, MD · Answer

High areolas after breast reduction can be corrected by elevating the inframammary fold.  This sometimes requires further reduction of the breast and may not be possible in some women.  A face to face consultation or photos are needed to better determine your options.

Heather Vande Ven, DO · Answer

If you've undergone breast reduction surgery and notice that one or both of your areolas (the darker area around the nipple) appear higher than expected, it's essential to communicate your concerns with your surgeon. There can be several reasons for the areolas appearing higher post-surgery, and your plastic surgeon is the best person to evaluate and address this issue.Some potential reasons for high areolas after breast reduction surgery include:1. Swelling: Swelling is a common post-surgical symptom. It might take some time for the swelling to subside, and as it does, the position of the areolas may settle into a more natural and lower position.2. Tissue tension: The tension in the breast tissues may affect the final position of the areolas. Over time, the tissues may relax and adjust to the new breast shape.3. Surgical technique: The surgical technique used can influence the final outcome. If there was a misjudgment in determining the appropriate areolar position during surgery, it might contribute to the issue.4. Healing process: Each individual heals differently, and factors like skin elasticity and tissue response can influence the outcome. Some adjustments may occur as part of the natural healing process.It's crucial to follow your plastic surgeon's post-operative instructions and attend any follow-up appointments to monitor your progress. During these appointments, you can discuss your concerns with your plastic surgeon, who may be able to provide insights into the healing process and whether any adjustments or interventions are necessary.Remember that healing is a gradual process, and it may take several months for your breasts to settle into their final shape. If you're experiencing discomfort, have concerns about the appearance, or if you notice any unusual changes, contact your plastic surgeon promptly for guidance. They will be able to assess your individual situation and recommend an appropriate course of action.

Connie Hiers, MD, FACS · Answer

You did not post photos, so I cannot be specific. However, many times only the underneath incision needs to be used to take out excess tissue and especially the skin. Many times the nipples are actually in the correct position, but the breasts have sagged. The scar can be revised at the same time.

Camille Cash, MD · Answer

I'm sorry that you had issues after your breast reduction.  Your plan to visit with a few board certified plastic surgeons in your area to hear varying opinions and explore options seems like a good one.  From your description surgical intervention will be needed in order to improve your results.  I've included a video I hope you find helpful.

Mats Hagstrom, MD (license on probation) · Answer

Breast reduction surgery does have a slightly higher chance of wound healing complications than most other plastic surgery procedures. Regardless, the procedure also has one of the highest patients satisfaction scores of any plastic surgery operations.
Tissue necrosis can happen because the blood supply to the tissue can be significantly altered during breast reduction. During the healing process new blood supply is generated, and this makes the chance of developing tissue necrosis during revision or secondary surgery much lower.
Lowering the areola, if placed too high can be challenging. Different plastic surgeons will have different approaches, but one of the more common ways of dealing with this is the lift the breast higher in relationship to the areola. Doing stone doesn’t lower the areola, but can improve the appearance.
We can’t really make an accurate assessment without seeing pictures.
My best suggestion is to follow up with one of the plastic surgeons you’ve consulted with or continue having consultations until you find a plastic surgeon you feel comfortable with to have the procedure if indicated.
Breast reduction surgery is generally covered by medical insurance and scar revisions can be covered by medical insurance in certain cases. 
Best,
Mats Hagstrom, MD

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