What's wrong with the donut lift?

Thank you for your excellent question.  I wish more patients would ask it.  I will start by telling you that over my 23 years in practice, some the worst results I have seen from breast lifts have been those in which the donut or "Benelli" lift was used.  I have seen a few acceptable results but those have been few and far between. This is supported by the fact that the largest number of malpractice suits from cosmetic breast procedures involve this type of lift.  In order to understand this, a little history is necessary.  The Benelli lift was developed by, you guesed it, Dr Benelli, a plastic surgeon in France who was looking for a way to treat smaller breasted women who had loose, slightly droopy breasts and did not want any increase in size.  In those patients the procedure can give very nice results since the actual breast tissue is reshaped and then the LOOSE skin is gathered in toward the areola after detaching it from the breast.  The problem is that over the years surgeons who don't seem to understand physics have tried to combine this technique with augmentation only to, in some cases, have disastrous results in order to avoid a vertical scar from the areola down to the inframammary fold as in the "lollipop" lift.  If you think about it, it makes no sense to, on the one hand place an implant that will to some degree fill out loose skin, then cut out a donut of skin around the areola and with sutures pull the skin in toward the reduced areola under tension.  Surgeons will place a "pursestring" permanent suture around the areola with the idea that it will keep the areola from widening.  This is what Dr Benelli describes for his patients with loose skin.  The problem with doing this under tension is that something has to give.  If the pursestring holds then the breast will tend to get flattened from the front, keeping it from having a pleasing conical shape.  If the pursestring breaks then the forces of tension will pull the areola outward, widening it and also possibly widening the scar.  If the skin has not been pulled in evenly then the areola will also become misshapen with a very irregular border.  If the patient had a very large areola to begin with and the outside incision of the donut was at the border of the areola then the breast will probably look like it would have looked had no lift been done at all.  In those cases it is usually possible to repair the result by converting to a "lollipop" without needing to remove the implant or place a smaller one.  If the outer circle of the donut was much larger than the areola then it is often necessary to remove the implant, making the breast smaller, so that it can be repaired.  This  because  so much skin has been removed with the donut that there is not enough skin left to convert to a vertical scar lift unless the volume of the breast is reduced.  Having said all that, it is important that the surgeon you decide to go with is certified by the American Board of Plastic Surgery and is also a member of The American Society for Aesthetic Plastic Surgery.  It may well be that your breasts are appropriate for a donut lift but if you decide to go that way you should ask to see several pictures of your surgeon's results in patients whose breasts look similar to yours as well as to ask him to show you pictures of some results that didn't go so well. I hope this has been helpful.

 By operative designed the donut mastopexy places the areola under tension as well as the surgical closure. This leads to flattened areola and often times wide scars. It does virtually nothing to the shape of the breast Except perhaps flatten the projection somewhat.

    I think that you have identified the problems with the lift.  It is appropriate for very few patients.Kenneth Hughes, MDLos Angeles, CA

A periareolar breast lift or donut lift can decrease the diameter of the areola and reposition the nipple areolar complex. It does tighten the skin around the nipple, which can flatten the breast. A high profile implant can help to eliminate the flattening with its shape. A periareolar breast lift is rarely indicated as a stand alone breast enhancement procedure. It is important to choose the right breast lift to help achieve the desired look.

The Benelli, or doughnut lift, is a lifting technique that involves making two successively larger circles around the areola, removing the skin in between the circles, and then closing the incision.This technique is best used for patients who need elevation of their nipple, but not removal of a lot of skin. If this technique is used inappropriately, excess tension results. This excess tension can cause the areola to spread and become widened. Many surgeons use a permanent suture, placed in a circular fashion around the areola, to help prevent areolar widening. When a significant amount of skin needs to be removed, a better choice is a lollipop incision. This uses an incision around the areola, and an incision that runs from the areola down to the crease under the breast, to reshape the skin and breast.In person consultation with a plastic surgeon will help you learn more about breast lift and determine which options are best for you. 

There's nothing "wrong" with the technique if it is used in the correct setting. (very small lifts, areola reductions).  When considering significant lifts or in combination with implants, I prefer not to use the peri-areolar lift.  Good luck and be safe.  John T. Nguyen, MD, FACS, FICSDouble Board Certified Plastic Surgeon

Thank you for your question.  The donut lift has fallen out of popularity because it in ineffective in significantly lifting the breast or changing nipple position and has poor long term outcomes.  The scar tends to widen as a result of undue tension on the scar with our without implants.  Considers other options such as s lollipop scar to improve overall shape and areolar scarring. Best wishes.

Yes, the donut lift does tend to both flatten and have scars widened as you are removing skin around the areola which causes tension in that single area causing it to "spring' apart over time. With the Lollipop incision the tension is spread out over a greater distance of the lower vertical scar (where the areola once was) causing less tension on the areola and entire closure. The vertical lift tends to cone the breast making it more shapely and less flat. For a visual take a paper circle, cut out a small wedge on the bottom and bring the edges together to see this effect.

Hello and thank you for asking this really important question.  This type of lift is for a breast with minimal drooping.  If you send pictures, I would be able to give you a good guess if it would be right for you.  However, I absolutely agree with what you read during your research.  If a breast is lifted with this technique and really needs a more aggressive lift, the odds are that the person will not be happy.  It does tend to flatten the areola area and not give a very good shape.  The scars are under tension so wide scars are common.  Those are really difficult to repair.  In my career, I have seen many bad results with this technique.  It is just not a good option in most.  Saving a few scars (which are hidden by bras and bathing suits) is not worth the poor shape and bad scars.Adding an implant may help but not always.  It is still a gamble as to the outcome.See experienced board-certified plastic surgeons for more opinions and good luck to you.

This approach can be appropriate in a very limited number of patients (I usually employ it for patients with constriction deformity and "herniated" areolae, or perhaps on one side only when a minor lift/areolar reduction is needed, with the use of a permanent deep suture), but by and large it has major limitations and is to be avoided.  Again (as detailed in the excellent response just posted by Dr. E, below), too much tension is usually placed directly on the nipple area (especially with implants placed), resulting in breast flattening, or "halo" scarring (and/or pleating, if an attempted is made at too aggressive a donut), and ultimately a disappointing if not unnatural/bizarre result.  I know that most patients don't want to hear about the need for a more extensive "lollipop" or "anchor" scar, but this places more of the tension below, away from the nipple, allows for better breast tissue redistribution/reshaping, and ultimately these more extensive (but better-appearing) scars are a very acceptable trade-off to create a better-shaped breast with a more normal-appearing nipple-areolar complex.