Does using a permanent stitch in an areola reduction surgery increase scarring?

You really do need a permanent suture to help prevent spreading of the areola with passage of time. The suture generally doesn't cause healing issues, and can be removed if needed, as your surgeon mentioned. If the suture is removed, however, the areola may widen more. The bottom line is that the suture is very important and is used by most plastic surgeons. 

Generally I like to use a permanent stitch placed in the deeper tissue to hold the tension of the reduction. I have found that overtime if you do not use a permanent stitch the areola will slowly enlarge. This stitch if placed a little deeper should not affect your healing.Ritu Chopra MD

This will usually help reduce widening of the areola and the scar.Kenneth Hughes, MDBeverly Hills, CA

Hello,A permanent suture is mandatory to ensure areolar reduction; otherwise the areola will re-expand to its original size.  Even with a permanent suture, re-expansion can be a problem, especially when too much skin has been removed.  The same can be said for scaring; the greater the skin resection, the more likely the scar will be thickened. Best of luck!

I have done many of these procedures over my 16 years of practice. I perform a purse string suture with a permanent suture. There is some pleating to the edge of the areola which flattens over time.  It is extremely successful and I have only had to remove one suture during this time. I agree with your surgeon and make sure he is using the purse string approach. All the best!

The use of a permanent pursestring suture in an areolar reduction procedure is important in maintaining your new, smaller areolar circumference.  Without it, your areola will slowly stretch back to almost its original size. If placed properly this suture will be tolerated by your body just fine, will result in a better scar and will be barely palpable if not at all. Good luck!Thomas Taylor, MD, FACSPasadena, CA

A suture permanently left in place will prompt a foreign body response until it is removed. This will result in a thicker scar.

In general, the permanent sutures that are commonly used for areola reduction are well tolerated and do not incite more scar tissue than dissolvable sutures. In most cases, the permanent purse-string suture provides a longer lasting result in terms of controlling the areola size and decreases tension on the final skin closure which helps produce a better scar. 

when its cinched to pull the outer skin to the size of the areola you have chosen to have.  Its a palpable edge that my patients have found to be unacceptable, necessitating removal (easy to do) later.  If your surgeon says you won't feel it, find out what happens if you can feel it and its a nuisance to you... will he remove it at no cost or will be be charged again?  I plan to use slow dissolving sutures that eventually disappear after 6 months so that rim will not be palpable.

The permanent stitch that your doctor is talking about is an internal stitch and does not increase the visible external scarring. In fact, it makes it less by preventing widening of the scar that always occurs without a permanent stitch! Rarely does the stitch come to the skin surface and if that happens, its removal does not lead to increased scarring. You may be able to feel the stitch under the skin, but patients don't seem to mind. Without the permanent stitch, however, the areola reduction will not work well.