Major circumareolar skin excisions create lots of problems that result in an undesirable breast appearance - flattens the top of the breast
-scars tend to be irregular, thick and wide
-areolar diameter tends to enlarge over time
-often done with implant placement
puts even more tension on the scar
-look at lots of photos of benelli or donut mastopexys
-can almost guarantee that you won’t like what you see
-why limit the scar to the around the areola if it makes that scar much more noticeable and distorts the shape of the breast?
Breast lift with implants benelli versus full mastopexy
A Benelli lift will solve the problem but this approach does not give you a tightness in the area below the nipple complex. In fact, because there are concentric circles with this lift (also called a donut pexy), there is a flattening of the breasts that sometimes can be noticable and sometimes is not. I do not think in your case that this would be a great issue but the bottoming you have will not be improved. With implants, this issue becomes less but here too is a problem. When an augment is done with the Benelli, then there can be an areola spread where the areola complexes increase in size. Not an absolute but a possibility.
In my opinion, it would all depend upon your feeling about a vertical scar. If you would accept it, then in my practice I would suggest a lolipop pexy with implants and with this, the areola spread possibility is decreased significantly as the circle is "locked" at 6 o'clock.
Discuss your thoughts with your surgeon and the right approach will be taken.
Breast Lifting Technique?
Thank you for the question and pictures.
Based on the pictures, I think you may have a very nice result with breast augmentation and circumareolar breast lifting. Of course, additional lifting will be necessary on your right side to improve symmetry as much as possible.
Lollipop vs Benelli lift for breast asymmetry
Without the benefit of a clinical examination and measurements it is not possible to give an exact answer to your question. It is probable that either procedure can be performed but the changes or improvement may not be the same. In general, breast lifts that have more scarring also provide more lift. Depending on how much lift you require or how much residual ptosis you will accept will determine which procedure is preferred and selected.
Although I know this is not a great answer to your question, I hope it is of some value to you and provides some help as you make your decision. Best wishes and good luck to you.
Periareolar lift plus an implant
In my opinion, you could have a nice result with implants on both sides and a periareolar lift on both sides. That way, you would have only scars around the areola and they would be equal on each side. You cam see many photos on my web site and RealSelf. You don't have a great starting point but could have some significant improvement.
In addtion to Breast Implants, which Breast Lift technique is advised?
The #BenelliLift, also known as the "DonutLift"to most surgeons, is performed by removing a donut-shaped piece of the areola and the surrounding skin. Followed by applying a #Pursestring, or, a double purse-string suture, to tighten the skin. Initally, a #Benelli was developed to access a majority of the breast through the incision. The breast is then shaped and lifted with sutures. This is a very complex procedure which is not often performed.
However, the term is widely used to refer to breast lifts involving an incision around the #areola. Most commonly, we prefer the lollipop or donut lift because of the shape, small scars and easier healing. Although the “anchor-shape” or inverted “T” incision is still more popular in the United States, it represents an older technique with extensive scarring and a less optimal result in many cases.
These newer techniques are utilized in the vast majority of cases, the rare exception being extremely large breasts. The nipple-areola complex is repositioned higher, the excess skin is removed, and the breast is reshaped in a pleasing contour and in a more normal position.
Benelli vs Lollipop Breast Lift
The key to success lies in letting you surgeon know
specifically what you would like to look like following the surgery. For
example, how perky do you want to be, what shape do you want to have,
etc.? However from your description it would appear that a lollipop
type lift would be best for you rather than a periareolar lift like the Benelli
procedure. Here is a rule of thumb that works for most patients. If you nipple
is above your lower breast crease then often a periareolar lift will be
sufficient for most patients. If your nipple is at or below your crease then a
vertical lift (lollipop lift), inverted T or anchor pattern may be required.
The Lollipop incision for Grade 3 or 4 ptosis (areolar near
or below your breast crease) works best in my hands and the use of a Lollipop
technique can lift your breast to the perkiness you desire. However, other
plastic surgeons are more comfortable with an inverted T or Anchor Pattern
technique.The donut lift does tend to both
flatten and have scars widened as you are removing skin around the areola which
causes tension in that single area causing it to "spring' apart over time.
With the Lollipop incision the tension is spread out over a greater distance of
the lower vertical scar (where the areola once was) causing less tension on the
areola and entire closure. The vertical lift tends to cone the breast making it
more shapely (conical) and less flat.
For a visual take a paper circle, cut out a small wedge on the bottom and bring
the edges together to see this effect. In general I would pick the best Surgeon
and explain fully what you want to achieve rather than the technique. Always
insist on a board certified Plastic Surgeon.
Lollipop Lift or Benelli Lift in Addition to Breast Implants?
You would benefit from an appropriately
sized implant to help restore lost volume and shape after breast-feeding. Complicating the situation is the asymmetry you have with
the right breast larger and more ptotic than the left breast. So you may end up
with different size implants along with either type of mastopexy; this is
best determined after a careful exam by your (board certified) plastic surgeon.
Candidate for a Benelli breast lift?
With proper implant selection and quality of your breast tissue you may be a candidate for a Benelli type doughnut mastopexy. This type of lift works best if you are only removing areolar skin. Also know that this type of breast lift has the highest rate of patient dissatisfaction if it is pushed too far.
Breast Lift decision is based on clinical examination
Without a clinical examination, it is very difficult to give you the correct answer. Based on your photo, it appears the left nipple is in good position, and a breast augmentation alone will give you a good result.
The right breast does need a lift, but the question is which type? It really depends on the amount of drop and loose skin in the lower portion of the breast. In general, if up to one inch of nipple lift is needed AND there is MINIMAL to NO loose skin in the lower portion of the breast, then a Benelli lift is indicated. Again, this in not always black and white, just a guideline.