Enlarged areolas after breast augmentation and crescent lift - is this due to the lift or augmentation? (photos)

Question

I’m just about at my 6 mo point post a BA with 385cc MP implants with a crescent lift that was rec by my PS. I feel that my areola is way over stretched and enlarged and am very unhappy with this. My PS did not educate me on that risk. He told me I had mild ptosis and would probably not be happy with how the outcome would be without a lift. Could I have gone without the lift ? He also did not rec high profile for my anatomy, but I feel that they would’ve sat higher if I did get HP?

Adam Tattelbaum, MD · Answer

Thank you for your question and the photos. When breast implants are placed everything stretches, both the skin and the areola. Because both stretch the breast still tend to look normal and proportionate. A crescent  can cause some elongation of  areola.  To reduce the size of the areola a circumareolar mastopexy can be performed, but beware that sometimes in this type of tightening the scar or the areola may widen. A high profile implant woud make you stick out more, but the height would only be higher with an implant that has a larger diameter. 
Lifting is a judgement call so It hard to comment on that after the fact.
hope this helps and best wishes.

Casey Anderson, MD, FACS · Answer

The recommendation of the lift seems reasonable based on the anatomy of your areolae. The areola widening can happen. It can be corrected with further surgery but would need a permanent cinch suture to keep it from spreading again.

High profile does not mean the implant sits higher. It means it projects further off of your chest.

High profile does not mean the implant sits higher. It means it projects further off of your chest.

Gerald Minniti, MD, FACS · Answer

Because of their design, crescent lifts pull on the most expandable skin and tissue of your breasts: your areola. Like a circumareolar lift, they do not increase the distance from the bottom of your areola to the inframammary fold either. So the result is elongated and expanded areola.  You will need a revision surgery preferably with a lollypop lift, which would leave you with perfectly shaped breasts, proper nipple position, and small areola with fine scars. Alternatively, you could convert to a circumareolar lift which puts you at risk for re-expansion of your areolas and thickened scaring (like you have now).

Daniel Barrett, MD · Answer

Dear enlightenedx3,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went 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

Michele A. Shermak, MD · Answer

Hello!
The implant stretches and fills out loose skin which includes the areola. I believe this is what happened. The crescent lift did not impact the areolar outcome - just raises them a bit. It looks like implants are under the pec muscle, but areolar enlargement is more common with under the breast or subfascial breast augmentation. The best way to take care of this is with areolar reduction with an incision all the way around the areola, known as a donut mastopexy. A permanent suture is used to hold the diameter in a reduced size. This may be done under local. Or you can exchange your implant for a larger size in a second operation, addressing the areolar diameter at that time. This procedure needs to be done right the first time - be sure to see a board certified plastic surgeon!
Best of luck to you!

Connie Hiers, MD, FACS · Answer

First, your breast naturally sit somewhat low on your chest and the base cannot be raised. the HP implants would not have sat high since your breasts does not sit high. Secondly, the areolae tend to stretch with the augmentation. However, your surgeon could go back about 4-6 months after your surgery and tighten them if you wish.  It's hard to get tissue to shrink when it is being stretched.

David Janssen, MD, FACS · Answer

When you increased the content that is within the envelope of the breast, the skin stretches. This is a side effect of the augmentation itself. You might be able to have your areolas tightened as an office procedure. You should go to your original surgeon and discuss your issues, as he/she will have a vested interest in your outcome and helping you become satisfied.

Douglas Taranow, DO, FACOS · Answer

You have many questions for your plastic surgeons results.  It is not uncommon for areolas to stretch a bit with breast augmentation.  No one knows how much the areolas will enlarge nor whether they will be more proportional now that the breast enlarge, so warning a patient is not always indicated.  A crescent lift minimally raises the breasts.  A periareolar lift would raise your nipples and reduce the size of your areolas.
Best wishes.
Dr. Taranow

Darryl J. Blinski, MD · Answer

The enlarged N/A are due to both reasons as you stated. Changing style of implants without going slightly larger in volume is the better option with reduction N/A surgery.
Fee $10,000