What's wrong with the donut lift?

Question

I have seen several surgeons telling me I could do the donut or lollipop lift. With research I have found that it flattens out the areola and the scar can widen. Why does this happen? Does this always happen? What if you do it with implants? Please let me know.

Vincent N. Zubowicz, MD · Answer

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.

Kenneth Hughes, MD · Answer

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

Andrew P. Trussler, MD · Answer

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.

Austin Hayes, MD · Answer

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.

John Nguyen, MD, FACS · Answer

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

George Bitar, MD · Answer

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.

Larry S. Nichter, MD, MS, FACS · Answer

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.

Robert J. Spies, MD · Answer

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.

Paul M. Steinwald, MD · Answer

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.

Shim Ching, MD · Answer

Spreading of the scar and flattening of the central portion of the breast can be an issue with donut lifts.  These problems manifest when more skin is removed.  Permanent sutures placed in a ring around the areola can decrease swelling, but I have found that patients can feel a ring of suture if the skin is thin.  Implants are often placed at the same time as a donut lift.

What's wrong with the donut lift?

Answers (20)

More Breast Lift Questions

Does it do any good to wear a bra at night after a mastopexy?

Why am I getting "soft spots" opening up around my areola 9 weeks after BL?

Estimate price for a breast lift (no implants) in Miami, FL? Also, what is process like for financing this type of surgery?

Is it bad to have a breast lift done if you are predisposed to breast cancer?

What type of scar is this? 6 mos. post benelli breast lift. (photo)

My breasts are naturally very saggy and I'm only 16. What would you recommend?

WE SEND PRETTY
EMAILS