I have large areolas, lack of tissue in the lower pole, what are my options? (Photos)

An important question. A lift and areolar reduction with address your concerns about nipple position and areolar size. At a consultation, you can discuss your goals for size and this will determine whether you will need an implant or not. If youre looking for a smaller increase in size, fat grafting can be a great option to augment the breast.
Best wishes,
Dr. Jan

Hi Singstar13,

Determining whether you need simply a breast implant versus a breast lift or both can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position.

Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just breast augmentation depending on the size of the implant the patient wants. I often use an implant when I perform a breast lift because it provides more upper breast fullness after the lift. Also, price range for breast lift is around 10k to 15k depending on whether you need a lollipop or a donut mastopexy.

Another important consideration to make would be the breast implant type and sizing selection. In fact, this is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 

When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.

Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.

Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.

You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery 

Member, Am. Society of Plastic Surgery

Thank you for your question. Please see a board certified plastic surgeon for an in-person assessment. Regards, 

If you are okay with the size of your breasts, as you state, then your areolas can be made smaller and lifted surgically. This could accomplish your goal.Dr. Ted EisenbergBoard-Certified Plastic Surgeon and Author

Hello and thank you for your question. You are a great candidate
for a breast augmentation with an areolar reduction.  A dual plane technique can be used to help with your lower pole.  Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Thank you for your question and photo's.   I would recommend an implant with areola reduction, with a possible lift .   You may have a mild form of tubular breasts,( which is fairly common),  but would be easier to assess in person.  Find a Board Certified Plastic Surgeon in your area for advice.

hello thank your for your question and provided information as well... evaluating your picture my recommendation in your case is , get breast augmentation with reduction aureoler.

Hi there Singstar and thanks for your question.
Firstly, let me reassure you, your breast shape is not uncommon at all!!! You would be surprised to realise that there are many other women with breast shapes very similar to yours. Without fully examining you, I suspect base on your pictures you have a mild degree of Tuberous breast deformity.
If you are happy with your breast size, then a simple breast lift procedure will give you the shape you desire and reduce the size of your areola. This is a fairly standard procedure and is very well tolerated.
You do not need implants, however once your breast shape is corrected, then a breast implant would be a fairly straight forward procedure as well

Best wishes

Richard

Hello, thank you for the question and I am sorry to hear that you are disappointed!
You need to see a Plastic Surgeon in person, to take a full history and examination and assess your own particular circumstances as well.
It would be a matter of assessing where you are in life, in terms of children, breast feeding, pregnancies, etc.
There will be a number of options available for you, function of your priorities, from just reducing the areolas, to implants, with or without reducing areolas, to fat transfer, an option of increasing slightly the volume and adjusting the size, without implants.
Good luck!

Hello, may I ask why you are hoping to avoid implants? 
Per your photos, you appear to have grade 2 ptosis (drooping) of the breasts where your nipple is below your breast crease and pointing towards the ground. While you should be evaluated and examined before recommendations are made, here are a few options to consider and discuss with your surgeon.
1) Breast lift without implants - this would require committing to scars on your breasts but would allow the surgeon to rearrange your breast tissue to sit higher on your chest and reduce the size of your areolae. Depending on your end goal, the scars could be around the nipple or could be more extensive lollipop or anchor style.
2) Fat grafting - If you have enough fat to spare and you accept that part of the fat transferred may not last (usually we say about 70% take in the breast), fat grafting could improve the contour in your upper chest and give more volume to the lower pole (like an implant but made of fat). You could pair this with an areolar reduction or periareolar lift to reposition your nipple and make it smaller. Generally fat grafting is not recommended for breast augmentation purposes unless you want to be less than a cup size larger and a lot of this depends on your examination.
3) Augmentation - an implant would replace the volume and give you a small lift if a dual plane method is used. Just an implant would probably make your areolae even larger (more volume there will stretch them out), so you may want to pair this with an areolar reduction or periareolar lift. Have an in depth conversation at your consultation to answer all your questions and concerns about implants before deciding.
Make sure you consult with a qualified plastic surgeon! I hope this helps. -Dr. Leong