Areola Scar Still Red, One Nipple Stretched out Bigger, What Can I Do to Fix These Issues? (photo)

Question

8mo PostOp Breast Aug. with saline implants mod profile under the muscle, I am unhappy with my results because i was looking for a different out come i.e clevage with a higher implant, minimal scaring, small nipples. but i feel as though my implants are low even though i had a "lift. the incision made around the areola seems as tho was furthur away from the actual areola making them seem even bigger.. Please any suggestions on what I can do to fix them, and also get the implants in a higher position

Vincent N. Zubowicz, MD · Answer

I'm not sure I would've recommended any type of a mastopexy based in the preoperative photographs. The doughnut mastopexy can increase the diameter of the areola through tension. This tension also contributes to thicker scars. You might require revision after scar remodeling is complete.

Pablo Prichard, MD · Answer

Dear Raquel,

	Thank you for your question and photos.  I understand your frustrations.  Unfortunately, saline implants are not for everyone, and neither are circumareolar lifts.  It looks like both are the case for you.  Saline implants are normally smooth, and in some patients tends to fall too much and sag very early.  There is a 'water hammer' effect that is very powerful in some patients and does not seem to affect others.  The areolar incision stays tight in some patients, and widens dramatically in others.  In your case, the redness of the incisions will eventually go away if you support your breasts 24/7 with a very supportive bra.  The strain on the incisions is keeping them inflamed.  While the redness will go away, the size of the areolas will not.  The shape will not get 'perky' on its own or have better cleavage.  I would suggest at this point a lollipop type lift with textured silicone implants to help keep them in place.  You will need a full capsulectomy to remove the body's capsule around the implant to have fresh tissue touching the implant to aid in adherence.  I would also suggest an 'internal bra' with a dermal matrix to help prevent future descent of the implants as well.  The lollipop type lift is needed as the tissue has been stretched by the implant.  However, as was said below, as the scars fade and are less red, this will be a more pleasing result.  You may wait until this happens and make a decision in the future.  Support 24/7 for now. 

	Best Wishes,

	Pablo Prichard, MD

Robert L. Kraft, MD, FACS · Answer

The position of the implants on your chest is relative to the pre-op location of the breasts. In terms of the scar hypertrophy, this should first be treated locally and, if it does not resolve, revision of the scars should be considered.  When the areolae scar well, the scars can be literally invisible but some patients do not heal that way.  This is one reason that most of my patients opt for the infra-mammary crease scar which isn't as overtly visible.

Jourdan Gottlieb, MD · Answer

Thanks for your question and for the attached photos. Expectations aside for the moment, I find myself looking at a pretty nice result, except for the scarring around the areola, which is hypertrophic. 

	The propensity for developing this sort of scar is primarily genetic, and not something to do with surgical technique. When scar creams fail, the next line of treatment for most surgeons is injections with kenalog, usually a series of three a couple of weeks apart. Although this is the "gold standard" it does not always result in improvement. Other options include laser,  and scar revision (surgery). 

	The areola does stretch out will implants, and this type of lift makes it more difficult to control the final size. Conversion to a vertical (lollipop) lift is more likely to decrease the areolar size, but I would be careful in deciding about making more incisions in light of how these have healed. 

	All the best.

Areola Scar Still Red, One Nipple Stretched out Bigger, What Can I Do to Fix These Issues? (photo)

Answers (4)

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