A word of caution: many surgeons perform what they call a 'circumareolar' (or 'donut' or 'Benelli' ) mastopexy. In my opinion there is absolutely no such thing as a 'circumareolar mastopexy'. Removing skin around the areola may enable a surgeon to elevate the position of the nipple/areola complex perhaps 1-2 cm on the breast mound, but it DOES NOT lift the breast itself. In most cases, unfortunately, it serves to distort the shape of the breasts, making them appear flattened at the top. If the breast needs to be lifted, it absolutely requires some internal rearrangement of breast tissue to create a projecting, aesthetically ideal and lasting result - which in turn requires that vertical incision and vertical surgical scar below the areola (and sometimes in the inframammary fold as well.
For several years I have been using a 'vertical scar' technique for most breast reductions, which eliminates the long, horizontal incision in the inframammary fold below the breasts. I have also adapted this technique for breast lift surgery, and have been extremely pleased with the results. As with breast reduction patients, this new technique not only eliminates the horizontal incision, but also creates more impressive breast projection and maintains it better over time. The breast lift procedure I perform not only removes breast skin but also moves some lower pole breast tissue to a higher position, increasing the projection of the nipple/areola area.
Breast lift surgery works well for patients with enough existing breast tissue to build a projecting 'breast mound'. However, in most breast lift Raleigh / Durham patients it is difficult to create sustainable fullness in the upper poles of the breasts by means of a mastopexy alone. This is particularly true in patients who have experienced significant deflation following pregnancy and lactation. For patients who indicate that they wish to achieve a fair amount of fullness in the cleavage area as a result of their breast lift surgery, I recommend that they undergo augmentation mastopexy. This surgery combines a breast lift with the placement of a breast implant usually of modest size, which produces the most youthful breast profile possible.
I have to agree with with most comments on this post. Ironically your scar will probably look much better with a vertical lift than with the benelli. A lift of 5.5 cm is asking a lot for a benelli. It will not only flatten the breast but most likely stretch the areola back to or larger than it's original size because of the tension around it. Furthermore, I find it difficult to shape the breast using that technique. There is more control with the vertical lift in that respect. I tell my patients that a benelli is best for simply moving the areola up 1-2 cm max- usually to achieve symmetry with the other breast. Hope this helps and good luck!
I'll take three to one odds anyday. You already know the answer to your question. A periareolar lift procedure is generally reserved for lifts of around 2cm. It sounds like you will need the lollipop. Good luck!
Both procedures are good for sagging breasts
Both procedures are good, and no one can tell you what to do in your particular situation without actually examining you themselves.
You understand the core issue of the debate: the Benelli lift has less scar, but it may not lift/tighten as much and the scar can be thicker or pucker. Without seeing you, it is impossible to know whether it would work for you.
I'd say this: 5.5 in general sounds like a lot to expect out of a Benelli. And, in general, if your SN:N is 26 as you say, 5.5 is probably more than you need to be lifted. The most common error with a breast lift, no matter the technique, is to raise the nipple too high. So I'd look into that again.
Be sure that your Benelli surgeon really understands what he/she is talking about and be convinced that they are highly experienced with that procedure before you select them.
And one more thing: most American surgeons call any breast lift with a scar just around the areola a Benelli. But Louis Benelli described much more than that: wide undermining with extensive reshaping of the breast. If your surgeon is calling it a Benelli, be sure he/she knows enough to know what a Benelli really is!
Lollipop Vs Benelli Lift for Sagging Breasts?
With the information that you furnished, it appears that at least a lollipop mastopexy would be required to give you your best result. I'm afraid I am not a fan of the Benelli (donut) mastopexy. The areolar generally expands back to its original size with time and appears distorted and flat.
My preferred treatment, if you have enough breast tissue, is to augment your breast with the lower portion of your breast, which would give you much more desirable shape and more fullness in the upper portion of your breasts.
If your breast tissue is an adequate, I would combine a mastopexy, but not a Benelli, with a small breast implant to achieve adequate volume in the upper pole of your breasts.
Thank you for your question.
What is the difference between the Benelli Lift and the Lollipop Lift?
The Benelli lift as performed by most surgeons is just the #donut lift, removing a donut shaped piece of areola and skin then using a #Pursestring or double purse-string suture to tighten the skin. A true Benelli actually will expose much of the breast through this incision and then the breast itself is shaped and lifted with sutures. With the “lollipop” technique, an incision is made around the areola and another between the areola and breast crease. This technique avoids a long #scar in the crease under the breast , which was an older technique known as the “anchor” or “inverted T.” Hence, Dr. Nichter or Dr. Horowitz prefer the “lollipop” technique or “donut lift” to avoid more significant scarring, rather than the majority of surgeons in the United States that use an anchor pattern lift.
Lollipop Breast Lift Best for Sagging Breasts over 2 Centimeters
Thank you for your question. I agree with most that a Lollipo Breast Lift is your best option since your sagging breasts have a Nipple Areola that requires 5.5 Centimeters of lift.
Trying to lift the breast this amount using a Peri Areolar Breast Lift will result in puckering and deformity that will be very visible and much worse that a well healed Lollipop Lift Scar.
Circumareolar Lift Vs. Lollipop Lift for Breast Sagging
You raise an excellent concern regarding breast lift options. Most patients would prefer to have minimal scarring (as would most plastic surgeons) with a breast lift. However, with a significant amount of lift necessary as in your case, there are limitations to the Benelli (Circumareolar) approach. While the Benelli approach can lift the nipple-areola, the larger the lift, the more likely that the circular scar wiill pucker, widen, stretch and flatten the breast (imagine you are pulling the drawstring up on a purse to close it...this is very similar to what is being done with a Benelli lift). The Lollipop lift can accomplish a sgnificant degree of lift while also reducing the areolar size (if necessary) and minimizing tension on the scars which significantly help scar healing. Additionally, the Lollipop lift does not flatten the breast and the scars themselves usually heal very nicely. In your case, you and your plastic surgeon need to decide if the lift can be adequately performed without the additional scar and if so, what can you realistically expect as your final result. Based on the information that you have provided, I would strongly favor a Lollipop lift. Best of luck!
I find a lollipop lift or a anchor lift gives a better shaped breast with out puckering
In the end you want the best shaped breast with out puckering. In my hands this is best accomplished with a lollipop or anchor lift with or with out a sub mammary gel implant. Benelli Lifts are some what variable in most surgeons hands.
Breast Lift Incision Type is dictated by the amount of Breast Ptosis
Thank you for your question. While I can sympathize with and share your desire to minimize or limit the amount of incisions as to prevent the amount of visible scarring after your procedure, I would stress to you the importance of making whatever your anatomy dictates are the appropriate incisions, in order to provide you with the best cosmetic result. Because of the amount of breast ptosis or sag that you are experiencing, the limited amount of lift that a Benelli lift or a circumferential areolar incision can afford, and without the ability to conduct my own physical exam I would caution you from opting for the Benelli lift. The biggest issues will be boosting your breasts up to the appropriate height, repositioning your breast tissue, and taking enough tension off of your closures to prevent poor scarring and a poor cosmetic result. With a Benelli Lift, I would worry that you would end up with misshapen breasts and wide scars.