Age 26. Is donut mastopexy an option? (photo)

Question

Age - 26. Sagging breast due to weight gain and subsequent weight loss. I only want a modest lift, as in nipple positioning a little and higher and pointing straight. I don't want implants. Is periareolar mastopexy an option? Do surgeons undertake periareolar mastopexy if the patients have grade 2 or 3 ptosis? Also will removal of fat from the sides ( bra bulges) without a lift worsen the sagging ?

Jonathan Heistein, MD · Answer

I think you need a full breast lift with anchor (Wise) scars.  A donut or periareolar mastopexy will not make your breasts look good.  You can remove the fat from the side of your chest without having it affect your breast sagging, but this could also be done at the same time as a breast lift.  Hope that helps.

Emre Guvercin, MD, FEBOPRAS · Answer

If your sagging is grade 2 or 3 ptosis, a periareolar (donut) mastopexy is not a reliable option, even if your goal is only a modest lift and you do not want implants.In those grades, a donut lift may slightly adjust nipple position temporarily, but it does not provide durable lift or shape correction and often leads to disappointment or early relapse.Why donut mastopexy is limitedA periareolar lift:Tightens skin only around the areolaProvides minimal vertical elevationDoes not reposition breast tissueRelies heavily on skin tensionHas a higher risk of:Areola stretchingFlattened breast shapeEarly recurrence of saggingBecause of these limitations, many surgeons do not offer donut lifts for grade 2–3 ptosis &mdash; and for good reason.What works better for your goals (no implants)For a modest but real lift with nipple elevation and forward-pointing nipples, the most appropriate option is a vertical (lollipop) Push-Up Breast Lift.A Push-Up Lift:Repositions your own breast tissue upwardElevates the nipple to a natural, forward-facing positionShortens the lower pole (key for youthful shape)Preserves sensation and future breastfeeding potentialDoes not require implantsProvides a stable, long-lasting resultIt addresses the cause of sagging, not just the skin.Do surgeons do periareolar lifts for grade 2–3 ptosis?Most experienced surgeons avoid it in these cases because:Results are unpredictableRevision rates are highPatients often need a vertical lift later anywaySome surgeons may agree if a patient insists &mdash; but that’s usually a compromise, not a recommendation.What about fat removal from the sides (bra bulges)?Yes &mdash; liposuction of the lateral breast/axillary area without a lift can worsen the appearance of sagging if done alone.Why:Removing side support can make the breast look more descendedIt can accentuate ptosis from the frontIf side lipo is planned, it’s best done together with a lift, so the breast is reshaped and supported at the same time.

Daniel Barrett, MD · Answer

Dear cniamh,

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

Joel Patrick Maier, MD · Answer

You are a great candidate for a mastopexy. The key to getting the highest, tightest, most durable lift is to remove the lower aspect of the breast. You will have the standard “anchor“ scar to achieve the proper lift. Periareolar approach is useless. Some would recommend the use of mesh which is good, but with extra cost. Liposuction of the front bra is usually need to complete the contour of the breast and transfer of the fat to the upper aspect of the breast is an excellent option to maximise your shape (not necessary, but an added perk if desired). I hope this helps. Thank you for the inquiry!

Oliver Chang, MD · Answer

Just based off your photos (views are limited and no physical exam) - usually with grade 2-3 ptosis, history of weight loss, breast fold extends into the axillary line - best option to really address all concerns and re-create the best shape would be to do a wise pattern breast lift. If you did do just a periaerolar lift, you have to be ready for breast to look similar to how they are now except your nipple / areola will be in a slightly higher better position. (This might be an option if you are willing to accept that and see how you heal and buy yourself more years of not having the anchor scar) Eventually if the goal is to address all the concerns is to be ready for the wise pattern lift.

Ajaya Kashyap, MD · Answer

Thank you for your query. A Donut mastopexy can work well for a small lift, otherwise you can end up with large areola over time. However a short vertical scar mastopexy will work well for you. Please find an experienced board certified Plastic surgeon who can examine you and help you with all your concerns. All the best!

Gulcin Nujen Cardak, MD, FEBOPRAS · Answer

According to your pictures, my professional opinion is that you need the vertical breast lift surgery. Your nipples are misplaced on horizontal plane also. With proper surgery, your nipples will replaced to higher and more central positions. Donut lift won’t help to remove all extra skin and this technique won’t allow your surgeon to reshape your breasts in to a youthful appearance.

Leila Kasrai, MD, FRCSC · Answer

A donut lift would not be sufficient, even if your goals are relatively modest. A full breast lift (anchor) would most likely be the most suitable option for you.

Bianca Knoll, MD · Answer

thank you for your question. "Donut" or periareolar breast lifts rarely work. The scar usually widens and the projection flattens, even if tension on the incision is reduced by using various techniques. It is understandable that patients are looking for the least amount of scars, but the outcome of your breast lift will be much better when a vertical breast lift ("lollipop"-incision) is used. In cases like yours, your own breast tissue can be used to achieve more of a projection and some upper pole fullness. This is called breast lift with autoaugmentation. I hope this helps.

Gary M. Horndeski, MD · Answer

A donut mastopexy would do nothing for your breasts. The technique I recommend is a lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them 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.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Age 26. Is donut mastopexy an option? (photo)

Answers (18)

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