Weird shape of breasts and very large areolas after periareoral Mastopexy with augmentation. Can this be improved? (Photos)

Question

Hello. I‘ve had my periareolar mastopexy with breast augmentation 6 months ago to improve th appearance of my tuberous breasts..I’m now abroad for some months, so cannot see my doctor for another consultation. Although I see that the shape of my breasts is questionable and areolas are very stretched. I had Sientra low profile round implants installed (left 210 cc, right 190 cc, to balance some asymmetry). anything can be done to improve the situation? Thank you

Daniel Barrett, MD · Answer

Dear Kind620038,

my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. The areolas can be reduced to the size you desire. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Donovan Rosas, MD · Answer

Areola can spread post augmentation. This becomes even more likely when a donut mastopexy is performed.

It is crucial that the diameter be locked with a permanent suture or the stress of the tightened envelope and the pressure of the underlying implant can lead to stretch.

With regards to your specific question, this can be revised. The areola can be re-tightened. However, the risk of spread will persist.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Guler Gamze Eren, MD · Answer

Hi from Istanbul! Thank you for your question.You have tuberous breast deformity and the breast tissue tends to herniate through areaolar in periareolar mastopexy.I would recommend a revision periareolar lifting surgery with reduction of the diameter of areola and use permanent stitches for areolar closure to prevent enlargement of areola. Best Luck!

John LoMonaco, MD, FACS · Answer

I had the pleasure of chatting with Louis Benelli, the developer of the technique.  He emphasized to me that the technique was ideally suited for smaller breasts, and was not the best choice to  accommodate an implant.

The reason is the areolar tissue is not strong  enough on it's own to hold an implant, which will stretch and flatten the areolar tissue, resulting in sagging.

The repair is to perform a "vertical lift" using a tennis-racket or lollipop-shaped scar

Tuan A Truong, MD, FACS · Answer

Thank you for your question! Correction of tuberous breasts can be challenging, particularly if the pre-operative breasts are very constricted with herniation of the glandular tissue through the inferior poles. A discussion with your surgeon would be helpful, including revision for the areolar size and perhaps implant exchange. The periareolar approach unfortunately did not appear to do much for "lifting" and runs the risk of widening after surgery - a lollipop or Wise-pattern approach may be more beneficial. If the discussion with your surgeon is un-satisfactory, a second opinion might be necessary.

Camille Cash, MD · Answer

For the optimal result I encourage you to consider a breast lift with implants.  This would give the best opportunity for your surgeon to reshape the breasts.  The periareolar approach does not really impact shape like a regular lift can. It would also improve asymmetry.  The areola tissue can be downsized too.

H. Daniel Zegzula, MD · Answer

I reviewed your pre-op photos from your post in 2023.  Looks like you have gained some weight and with the implants your breasts are significantly larger.  Overall the shape is MUCH better.  You still have an asymmetry of size and your areolas have stretched and the scars a a little wide.

I wonder if a permanent suture was used for the periareolar mastopexy?  A redo periareolar mastopexy with a permanent suture and might help the size of your areolas.  The problem is it can flatten the shape of the breast, the scarts may thicken again and possible distortion of the shape of the areolas...

A redo mastopexy with a vertical scar and possible short scar in the fold would get you a better shape.

Good luck.

Weird shape of breasts and very large areolas after periareoral Mastopexy with augmentation. Can this be improved? (Photos)

Answers (8)

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