Concerned about traditional reduction technique due to very small and light areolas. (photos)

I m 53 yrs old, 5'1", 110 lbs and a 34DD. I am post menopausal and am so ready to get my body back. I am concerned with scarring around the nipple due to my fair skin and small areolas. Is there any way to avoid this? I was a 34C until menopause and estrogen replacement. Would love to get down to a full B or small C.

Doctor Answers 5

Scar With Lighter Skin

In general, your skin type should be more favorable to produce an acceptable scar. It's my experience that the vertical (lollipop technique) produces overall less scar than the anchor scar method, and those scars are often of better quality.  When downsizing the breast, there is typically less tension on the skin which is a good thing when avoiding unfavorable scars. Scar reduction techniques are a routine part of our postop care, and also play their role.


Houston Plastic Surgeon
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Concerned about traditional reduction technique due to very small and light areolas. (photos)

As a matter of fact lighter skin is more favorable for scarring, especially around the areola.  Some of my colleagues would recommend a vertical (lollipop) technique for you, but that will put more tension on the scar around the areola and in my opinion an inferior pedicle Wise pattern would give you a better result.  Best of luck.

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 17 reviews

Scarring with breast reduction

The options for scar placement for a breast reduction, depending on each person's breast size, are a "lollipop" incision or an "anchor" incision.  The "lollipop" or "keyhole" incisions include an incision around the areola and a vertical incision from the bottom of the areola to the bottom of the breast.  The "anchor" incisions include those used for the "lollipop" incisions but also include a transverse incision that runs along the bottom of the breast, much where the underwire of a bra would rest.  There is no way to not have a scar around the areola with breast reduction surgery.  That being said women with lighter skin tones tend to have the best chances for the best scarring.  Scars look worse before they look better.  They are pink/red, raised, firm, lumpy for the first 6-8 weeks.  After 6-8 weeks, and sometimes a little sooner, the body will start to remodel the scar to make a nicer scar that is lighter, flatter and softer.  The scar will continue to improve for years and years but will do a lot of improving that first year.  It is hoped that your scars will heal in nice thin, white or pink lines.  There are scar treatments that can be done to try to decrease the prominence of the scar after surgery.  My breast reduction patients are some of my happiest patients and a lot of them say they wished they would have done it sooner.  Best of luck in your decision.

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Concerned about traditional reduction technique due to very small and light areolas.

Thank you for the question. Based on your description, you may be an excellent candidate for breast reduction surgery. This operation tends to be one of the most patient pleasing operations we perform. 
“Typical” patients who present for breast reduction surgery are women who have disproportionately large breasts, causing problems such as neck/back/shoulder discomfort, postural changes, bra strap grooving, skin irritation/rashes under the breasts, and/or difficulty with activities of daily living and/or exercise etc. There may be both physical as well as psychosocial “stress” caused by the disproportionately large breasts. Reducing breast tissue mass and elevating the breasts on the chest wall tend to improve or alleviate many of the symptoms associated with the disproportionately large breasts. Patients considering breast reduction surgery should also consider the potential downsides (risks/complications) associated with the procedure as well. Poor scarring, for example may be associated with the procedure. Additional surgery may be necessary in the short or longer term for a multitude of reasons.With the goal of improving communication with my patients I find the use of photographs of “goal” pictures (and breasts that are too big or too small) very helpful. I have found that the use of words such as “natural” or “full B or small C cup” means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
When the time is right, I suggest that you seek consultation with well experienced plastic surgeons who can demonstrate significant experience achieving the types of outcomes you would be pleased with. Ultimately, careful selection of your plastic surgeon will be the most important decision you make. To this end, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.  I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps. Best wishes.

Breast reduction - concerned about scars

Thank you for asking about your breast reduction.In my experience, women with small, light areolae tend to have excellent scars - much better than average. So I suggest you see a plastic surgeon to see where the scars will go so you understand what will be done. Breast reduction is an excellent operation - you are likely to be happy from the start! Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.