I want a lift and breast implants. Am I a good candidate for a circumareola lift? Or will I need a lollipop incision? (Photos)

I am doing some googling on different type of breast lifts. I am trying to avoid major scars. I want upper fullness, lift, and volume. Can I get that with a circumareola? Is this a big risk of scar stretching and a pleating look?

Doctor Answers 38

What type of breast lift will I need with my breast implant?

Thank you for your question.  Although your best assessment is done with an in-person consultation with a plastic surgeon, from your photographs it appears that you would benefit the most from a breast implant with a vertical (lollipop) or wise-pattern (anchor) incision mastopexy (breast lift).  I think this will help you achieve the improved breast fullness, lift, and volume you mentioned in your question.  In regards to the circumareolar (donut) mastopexy, I think this would put significant tension on your areolar perimeter, and not only widen the scar in time, but also flatten your areola and limit breast projection by flattening your anterior breast.

There are a number of important points to discuss about a breast augmentation and a breast lift.

In terms of the breast augmentation, the first step is to have a detailed discussion to clearly define your desired breast outcome goals – this would include the size you would like to achieve, and your ideal breast shape.  I would then select the best breast implant for you based on volume of the implant, contents of the implant (saline vs silicone), shape of the implant (round or anatomic), surface of the implant (smooth or textured), position of the implant (over or under the pectoralis muscle, skin stretch of your breast (more stretch would require a larger volume to fill, as in your breast), degree of breast sag (which would benefit more from a lift), breast diameter and overall chest circumference, native breast tissue volume, and any history of prior surgery or trauma to the breast.

When it comes to the breast lift, the degree of breast and nipple droop will determine the type of incision necessary to lift the breast.  Although I gave you a preliminary assessment above from your photographs, an exam in person would allow me to truly evaluate the "substance" of your breast and get a sense of how "full" your breast is, and determine the type of breast lift you would most benefit from.  In terms of the incision, there are many types of breast lifts (with different incisions) which include the donut, lollipop, and anchor incisions.  For more details on each of these breast lifts, please refer to the link below.  Again, from your photographs, I think you most likely benefit from a vertical or anchor incision for the reasons mentioned.

The next step for you is to find the right aesthetic plastic surgeon.  In your consultation, be sure your surgeon addresses all your concerns and discusses the surgery details including the position and size of the incision used, the type of breast implants available, the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in women who have a similar breast appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

And lastly, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired breast outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

Good luck.

Mark K Markarian, MD, MSPH

Harvard-trained Aesthetic Plastic Surgeon

What type of breast lift will I need with my breast implant?

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Thank you for your question.  Although your best assessment is done with an in-person consultation with a plastic surgeon, from your photographs it appears that you would benefit the most from a breast implant with a vertical (lollipop) or wise-pattern (anchor) incision mastopexy (breast lift).  I think this will help you achieve the improved breast fullness, lift, and volume you mentioned in your question.  In regards to the circumareolar (donut) mastopexy, I think this would put significant tension on your areolar perimeter, and not only widen the scar in time, but also flatten your areola and limit breast projection by flattening your anterior breast.

There are a number of important points to discuss about a breast augmentation and a breast lift.

In terms of the breast augmentation, the first step is to have a detailed discussion to clearly define your desired breast outcome goals – this would include the size you would like to achieve, and your ideal breast shape.  I would then select the best breast implant for you based on volume of the implant, contents of the implant (saline vs silicone), shape of the implant (round or anatomic), surface of the implant (smooth or textured), position of the implant (over or under the pectoralis muscle, skin stretch of your breast (more stretch would require a larger volume to fill, as in your breast), degree of breast sag (which would benefit more from a lift), breast diameter and overall chest circumference, native breast tissue volume, and any history of prior surgery or trauma to the breast.

When it comes to the breast lift, the degree of breast and nipple droop will determine the type of incision necessary to lift the breast.  Although I gave you a preliminary assessment above from your photographs, an exam in person would allow me to truly evaluate the "substance" of your breast and get a sense of how "full" your breast is, and determine the type of breast lift you would most benefit from.  In terms of the incision, there are many types of breast lifts (with different incisions) which include the donut, lollipop, and anchor incisions.  For more details on each of these breast lifts, please refer to the link below.  Again, from your photographs, I think you most likely benefit from a vertical or anchor incision for the reasons mentioned.

The next step for you is to find the right aesthetic plastic surgeon.  In your consultation, be sure your surgeon addresses all your concerns and discusses the surgery details including the position and size of the incision used, the type of breast implants available, the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in women who have a similar breast appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

And lastly, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired breast outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

Good luck.

Mark K Markarian, MD, MSPH

Harvard-trained Aesthetic Plastic Surgeon

Breast lift

In my experience patients such as yourself with grade III ptosis (nipples below the level of the breast fold) do not get good results with circumferential breast lifts, and the photo you've posted as a desired result would need a vertical mastopexy (also known as "lollipop" breast lift).  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search. 

Breast lift

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In my experience patients such as yourself with grade III ptosis (nipples below the level of the breast fold) do not get good results with circumferential breast lifts, and the photo you've posted as a desired result would need a vertical mastopexy (also known as "lollipop" breast lift).  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search. 

3 Ways a breast lift is done

It appears as though you'll most likely need the lollipop or vertical lift.  Circumareolar will most likely result in wide scars.  Here are the 3 ways a breast can be lifted:

1.  Around the areola (circumareolar)

2.  Vertical (lollipop)

3.  Anchor lift

Sometimes, a breast implant can be placed at the same time.  However, I caution those women who need a lift and who desire very large implants at the same time.  This can lead to poor scarring and lack of blood flow to the nipple/areola complex.

Thank you for your question!

Dr. Schreiber

3 Ways a breast lift is done

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It appears as though you'll most likely need the lollipop or vertical lift.  Circumareolar will most likely result in wide scars.  Here are the 3 ways a breast can be lifted:

1.  Around the areola (circumareolar)

2.  Vertical (lollipop)

3.  Anchor lift

Sometimes, a breast implant can be placed at the same time.  However, I caution those women who need a lift and who desire very large implants at the same time.  This can lead to poor scarring and lack of blood flow to the nipple/areola complex.

Thank you for your question!

Dr. Schreiber

The right incision for you

There are a variety of techniques for these operations. Most commonly there is an incision around the areola and another between the areola and breast crease. This technique is referred to as the "lollipop" technique and avoids a long scar in the crease under the breast (older anchor technique). On occasion, especially with mastopexy, these incisions may be modified and more limited. If breast sagging is minimal, the procedure may only require the incision around the areola. It is unusual to use the "anchor" or "inverted T." This is an older method that creates as much as twice the scar and can flatten the breast, creating less forward projection and suboptimal shape.

The nipple-areolar complex is repositioned higher, the excess skin is removed, and the breast is reshaped to a pleasing contour that is more normally positioned.

In some cases, the insertion of an implant, may be advisable, or your own fat can be transferred to enlarge and shape the breast. This is the "California Breast Lift" or Natural Breast Enlargement

The right incision for you

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There are a variety of techniques for these operations. Most commonly there is an incision around the areola and another between the areola and breast crease. This technique is referred to as the "lollipop" technique and avoids a long scar in the crease under the breast (older anchor technique). On occasion, especially with mastopexy, these incisions may be modified and more limited. If breast sagging is minimal, the procedure may only require the incision around the areola. It is unusual to use the "anchor" or "inverted T." This is an older method that creates as much as twice the scar and can flatten the breast, creating less forward projection and suboptimal shape.

The nipple-areolar complex is repositioned higher, the excess skin is removed, and the breast is reshaped to a pleasing contour that is more normally positioned.

In some cases, the insertion of an implant, may be advisable, or your own fat can be transferred to enlarge and shape the breast. This is the "California Breast Lift" or Natural Breast Enlargement

I want a lift and breast implants. Am I a good candidate for a circumareola lift? Or will I need a lollipop incision?

Although I am an advocate of Benelli lifts (periareolar lift) for appropriate patients, I feel strongly that you will not get anywhere near the result that you seek without a J-Mastopexy or an anchor pattern full mastopexy with implants.  These will give you the best chance of obtaining a result similar to that which you show as your goal.

Meet with an ABPS Bd Certified plastic surgeon or two and discuss your priorities and options after reviewing photos of others.

Best wishes,

Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Member, ASAPS, ASPS

Extreme Makeover Surgeon, ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

I want a lift and breast implants. Am I a good candidate for a circumareola lift? Or will I need a lollipop incision?

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Although I am an advocate of Benelli lifts (periareolar lift) for appropriate patients, I feel strongly that you will not get anywhere near the result that you seek without a J-Mastopexy or an anchor pattern full mastopexy with implants.  These will give you the best chance of obtaining a result similar to that which you show as your goal.

Meet with an ABPS Bd Certified plastic surgeon or two and discuss your priorities and options after reviewing photos of others.

Best wishes,

Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Member, ASAPS, ASPS

Extreme Makeover Surgeon, ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

The Bellesoma Method

Thank you for your question and photos, 

You do not need implants! All you need is a breast lift that will use your own tissue to fill the top of your breasts. The Bellesoma Method was not only designed to achieve upper pole fullness without implants, but it has also eliminated the dreaded vertical scar component. Breasts are beautifully reshaped and elevated with minimum scarring. Long term results are this technique's hallmark. An internal support is fashioned using a woman's own tissue to keep the newly shaped breast high for years to come. Nipple sensitivity along with the ability to breast feed is also preserved. Remember, implants are not stable devices and as such require maintenance in the form of costly revisions. 

I hope this helps. 

Best wishes and kind regards, 

Dr. Gary Horndeski

The Bellesoma Method

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Thank you for your question and photos, 

You do not need implants! All you need is a breast lift that will use your own tissue to fill the top of your breasts. The Bellesoma Method was not only designed to achieve upper pole fullness without implants, but it has also eliminated the dreaded vertical scar component. Breasts are beautifully reshaped and elevated with minimum scarring. Long term results are this technique's hallmark. An internal support is fashioned using a woman's own tissue to keep the newly shaped breast high for years to come. Nipple sensitivity along with the ability to breast feed is also preserved. Remember, implants are not stable devices and as such require maintenance in the form of costly revisions. 

I hope this helps. 

Best wishes and kind regards, 

Dr. Gary Horndeski

Type Lift with Breast Implants

Crescent lift will elongate the areola and does very little.  The periareolar lift can move the areola a bit, but will not lift the breast.  The lollipop lift has the ability to truly lift the breast.

Select an American Board of Plastic Surgery board certified plastic surgeon who has performed hundreds of breast lifts with favorable patient reviews, and has untouched before and after photos on his or her website.  Schedule on in-office consultation for you to explain your goals, express your concerns, and arrive at the best plan for you to achieve your goals.

 

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Type Lift with Breast Implants

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Crescent lift will elongate the areola and does very little.  The periareolar lift can move the areola a bit, but will not lift the breast.  The lollipop lift has the ability to truly lift the breast.

Select an American Board of Plastic Surgery board certified plastic surgeon who has performed hundreds of breast lifts with favorable patient reviews, and has untouched before and after photos on his or her website.  Schedule on in-office consultation for you to explain your goals, express your concerns, and arrive at the best plan for you to achieve your goals.

 

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Circumareolar Lift Is Inadequate

Woman to woman, I understand wanting to have limited scars on the breasts, but a circumareolar lift will not give you the results you want. Often with plastic surgery you have to exchange more scar for improved contour. It's a compromise. You should focus on before photos of women's breasts that look like yours. You can't compare breasts that did not need a lift or that have minimal ptosis with your preoperative breast appearance and expect the same result. Also, you have a wide gap between your breasts and the photo you put up as your wish photo does not. You should expect a gap, even after your procedure. Ultimately, the goal is to improve the appearance of your breasts. Comparing yourself to others can lead to disappointment. Best of luck. 

Millicent Odunze-Geers, MD, MPH
Sacramento Physician
4.7 out of 5 stars 6 reviews

Circumareolar Lift Is Inadequate

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Woman to woman, I understand wanting to have limited scars on the breasts, but a circumareolar lift will not give you the results you want. Often with plastic surgery you have to exchange more scar for improved contour. It's a compromise. You should focus on before photos of women's breasts that look like yours. You can't compare breasts that did not need a lift or that have minimal ptosis with your preoperative breast appearance and expect the same result. Also, you have a wide gap between your breasts and the photo you put up as your wish photo does not. You should expect a gap, even after your procedure. Ultimately, the goal is to improve the appearance of your breasts. Comparing yourself to others can lead to disappointment. Best of luck. 

Mastopexy necessary with augmentation if breasts sagging, don't want a "waterfall" deformity

Thank you for your question and for providing the photographs.  It appears from your photos that you will need a lift; probably with a lollipop scar.  However, this depends on the style and size of the implants that are used for the augmentation.  Keep in mind that in general scars heal well and should fade over time.  As you pointed out, in some cases with a periareolar scar only, the scar will be very pleated and will look like a widened scar.  This can be difficult to correct.  If a lollipop pattern scar is needed, it is being done to produce a very fine peri-areolar scar.  This is necessary if the distance that the nipple needs to be elevated is more than approximately 2cm, although this varies.  What you don't want, is to have the implant sitting in the correct position and then have the breast tissue "waterfalling" or sagging off the edge of the implant.  I find in some patients that using a high profile shaped implant can avoid a lift in some cases.  I also find textured implants advantageous and the use of Galaflex mesh is also very helpful.  Your pictures indicate some asymmetry.  Be sure and discuss with your plastic surgeon the pros and cons of removing some tissue from the left side versus using different sized implants.  In my practice, with the degree of asymmetry you have, I would recommend tissue removal from the left side to create better symmetry.  A final caution, do not use an overly large implant to avoid a lift.  In the long run, you will not be happy.

Mastopexy necessary with augmentation if breasts sagging, don't want a "waterfall" deformity

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Thank you for your question and for providing the photographs.  It appears from your photos that you will need a lift; probably with a lollipop scar.  However, this depends on the style and size of the implants that are used for the augmentation.  Keep in mind that in general scars heal well and should fade over time.  As you pointed out, in some cases with a periareolar scar only, the scar will be very pleated and will look like a widened scar.  This can be difficult to correct.  If a lollipop pattern scar is needed, it is being done to produce a very fine peri-areolar scar.  This is necessary if the distance that the nipple needs to be elevated is more than approximately 2cm, although this varies.  What you don't want, is to have the implant sitting in the correct position and then have the breast tissue "waterfalling" or sagging off the edge of the implant.  I find in some patients that using a high profile shaped implant can avoid a lift in some cases.  I also find textured implants advantageous and the use of Galaflex mesh is also very helpful.  Your pictures indicate some asymmetry.  Be sure and discuss with your plastic surgeon the pros and cons of removing some tissue from the left side versus using different sized implants.  In my practice, with the degree of asymmetry you have, I would recommend tissue removal from the left side to create better symmetry.  A final caution, do not use an overly large implant to avoid a lift.  In the long run, you will not be happy.

I want a lift and breast implants. Am I a good candidate for a circumareola lift? Or will I need a lollipop incision?

Thank you  for your question and the pictures. I would have concerns that the breast augmentation and Benelli (circumareolar) breast lift will not be powerful enough to achieve an outcome that you will be pleased with. Although I understand your concerns regarding scarring, most patients would prefer to have an optimized long-term contour and accept the  trade off additional scars.   Although difficult to understand, a full mastopexy often results in better scarring compared to a Benelli breast lift where all the tension of the breast lift is placed on an incision around the areola only.  


My best advice: select your plastic surgeon very carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully as well. Working together you will come up with a good plan to achieve your goals. Best wishes. 

 

I want a lift and breast implants. Am I a good candidate for a circumareola lift? Or will I need a lollipop incision?

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Thank you  for your question and the pictures. I would have concerns that the breast augmentation and Benelli (circumareolar) breast lift will not be powerful enough to achieve an outcome that you will be pleased with. Although I understand your concerns regarding scarring, most patients would prefer to have an optimized long-term contour and accept the  trade off additional scars.   Although difficult to understand, a full mastopexy often results in better scarring compared to a Benelli breast lift where all the tension of the breast lift is placed on an incision around the areola only.  


My best advice: select your plastic surgeon very carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully as well. Working together you will come up with a good plan to achieve your goals. Best wishes. 

 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.