Why did my areolas re-stretch? What other options are there? (Photo)

Question

I had an areola reduction surgery over a year ago and now they look exactly as they did before, but with a scar. I feel like it was a 5k wasted and incredibly disappointed in the results. What more can I do?? What other options are there??

Oliver Chang, MD · Answer

Based off your photo - seems that you have stretched and the skin has grown since your surgery a year ago. (unsure of the preop and immediate post op looks) If the reduction was done accurately with enough taken out, ideally the stretch should last longer than a year but again depends on surgeon's technique and your skin genetics. Recommend you to go back to your original surgeon for a possible revision or redo (likely they will do it at a cheaper price than the first time) or seek second, third opinions. You have a scar already, so this next one will have the same scar but be ready for possible thickening of the scar or possibly reduction of your sensation to the nipple and surrounding area (as you cut more, it loses more feeling). Hope this helps.

Donovan Rosas, MD · Answer

Areolar reduction followed by recurrence?T his is commonly encountered after reduction and is the result of excess tension. Over time the tension on the purse-string suture can result in repeat dilation.

This complication can be avoided by limiting the degree of tension via conservative reduction. The less tightening performed the lower the tension on the repair. Additionally, placement of a permanent suture that will lock on the diameter and counter the tendency to dilate/stretch over time.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Daniel Barrett, MD · Answer

Dear Giving371725,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

There are a few reasons that the areola can restretch even after surgically downsized.  One of the main reasons is tension on the sutures. Sometimes using permanent sutures can help.  I encourage you to discuss your concerns with your surgeon and learn more about options for further correction.

Darryl J. Blinski, MD · Answer

Based on your nicely posted photos, it appears your nipple complex reduction was done with dissolving sutures, and not a permanent suture?. Best to ask the previous surgery what type of sutures were used. Best to do a virtual consultation. The only option is a secondary nipple complex reduction, using permanent sutures with either micro fat grafting, sub nipple complex for denting With syringe Lipo to obtain the fat, fee $5000. Or nipple complex reduction with ALLOCLAE injections sub nipple F fee $10,000 due the cost of the injection materials. Best of virtual consult with for better understanding.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a procedure we need to see before and after pictures.
If you don’t have before, and after pictures and ask your surgeon to forward the pictures they took.
The areola can stretch out after surgery for a number of reasons.
If too much skin is removed and the procedure is done as a circle or donut fashion then there’s going to be constant tension to pull the scar wider and stretch out the skin after surgery.
Sometimes it’s related to how the procedure was done.
Sometimes there are genetic differences in the skin of different patients.
 This varies significantly.
What you describe is not at all uncommon esp after an aggressive reduction using this technique. 
Best,
Mats Hagstrom MD

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