Areola reduction w/ implant. Is it risky because the implant might stretch the areola? Will the scar be visible forever? (photo)

To a certain extent augmentation and mastopexy (areolar reduction) have competing goals. One is expanding the envelope while the other constricts. The challenge is achieving a balance between the two.These two procedures are commonly performed together but can be staged. By doing so, you avoid the added stretch on the periareolar closure (which will subside as the tissue stretches post augmentation). One way in which to counteract this stretch is to place a permanent goretex cinch around the areola setting the areolar diameter permanently.With regards to scarring, the scars are generally well tolerated. They are permanent but they will fade over time.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

It is not uncommon to reduce the areola at the time of breast augmentation, but it is at the expense of some kind of scar.  It is a trade off.  There is some theoretical advantage to doing this in stages.  On the day of a breast augmentation, there is increased tension on the areolar closure, especially with bigger implants.   6-12 months later, there is less tension and may yield better scars.  

Everyone scars differently and reacts to implants differently.   I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified Beverly Hills Plastic Surgeon

Dear brbote,it is not unusual to combine breast implants and areola reduction. I do it quite often in my practice. We specialize in minimal scars. Its starts with a peri-areolar incision that hides the scar at the border of the areola. Next, I close my incisions in 5 layers and take stitches out week one and week two.  I don't recommend absorbable sutures because they cause inflammation that worsens scars. Then we tape your incisions once a week for 6 weeks. Lastly we start you on a 3 month topical scar management protocol with a scar gel thats FDA approved. I would suggest you to consult a board-certified plastic surgeon. You will get the best recommendations after a thorough examination.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

It is perfectly reasonable to undergo an areolar reduction at the same time that implants are inserted.  Many Plastic Surgeons will utilize a "blocking suture" to maintain the new, reduced areolar diameter which should counteract the stretching effect of the implant.  Implant size would only be restricted at the upper limit of volume for your breast to prevent undue tension on the closure around the areola.  Find a surgeon with significant experience in both procedures and you should have a good result.

depends on sutures to keep the scar from spreading out and it is counter to what the implant is trying to do (stretch your tissue out).  Rather than have yin and yang battle, seems better to do the augmentation first and then the areola reduction in the office to minimize the tension on your incisions and to give you the best scar that WILL be visible in some way or form.  And if you are really having a lift, a traditional lollipop lift is way better for reducing the areola rather than the Benelli (around the areola) because Benelli's flatten projection, leave a palpable ridge at the scar where your suture is, and will result in crazy stretched out scars if the suture fails.  I only use it as a last resort procedure.

For patients with large areolas or asymmetry, I recommend performing an areola reduction with the scars along the border of the areola. The scar tends to hide well at the junction of the color change from the darker areola to the lighter skin. Areola reduction can be performed at the same time as the implant placement but done as the last part of the procedure so the risk of stretching is minimized since the implant has already been placed. Special techniques and suture materials are also used to prevent the areola from stretching after the surgery. It is best to have an in-office examination to determine and demonstrate the best treatment plan for your case. Hope this helps!Johnson C. Lee, MD Plastic Surgery@drjohnsonlee

You would need a consultation to determine implant size based on chest size.  Of course, you will ultimately decide the implant size in the office.  Areola reduction with the scar just around the areola can be done at the same time.  However, the areola does tend to stretch over time.

hello thank you for you question , 
this type of surgery is not uncommon, it is common for patients who want to reduce their nipples and breasts, have no risk of placing implants, or that the nipple will stretch.on the contrary the nipple will be reduced to a level that looks natural.
what if you have to have attention is with recovery, because if you do this procedure you have to take precautions the first month, handle, raise your arms, carry heavy things to your wallet.all that effort can cause the scar to become thick or hypertrophic.it also influences your skin, because there are types of skins that can make coarse or keloid cicatizing but ideally if you have all the precautions possible and are taken from the indications of your surgeon your recovery 

For patients with wide areolae undergoing breast augmentation, an areolar narrowing through a periareolar approach should be a consideration since the weight and tension on your skin from the implant is likely to stretch your areolae.  You can test this by looking in the mirror and stretching the skin about your nipple to see how wide your areola becomes.  The question of whether an incision line or scar is worthwhile becomes a decision to be made with your plastic surgeon.  Most patients who undergo a periareolar lift find the scarring to be acceptable, however in some cases the scar does widen and stretch.  In all cases however one needs to expect that the line will never disappear and will always be present.Discuss your options with your surgeon and as always, avoid too large an implant for your breast tissue and skin to accept comfortably.Best wishes,Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery, 
Member, ASAPS, ASPS

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