Is it possible to do a donut breast lift with areola reduction and smaller implants on my breasts? (photo)

Hi, First after my augmentation (900cc each) they looked great, but now my natural breasts (34DD before surgery) dropped down (also one sits higher). Therefore, I would like to get a breast lift with areola reduction, and smaller implants (500 to 600cc). I would like the areolas to be really small, and placed high on my breasts, and I would like the fatty tissue of my natural breasts removed. Is it possible to achieve a good result with a donut lift, or is another lift necessary? Thank you.

Doctor Answers 10

Reductive Augmentation

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Your problem is quite common, and I have developed a procedure for exactly this scenario that includes: downsizing the implant, making the pocket smaller by suturing - capsulorrhaphy, breast lift, and excision of redundant breast tissue in the inferior pole of the breast. I term this "Reductive Augmentation". 

Del Mar Plastic Surgeon
4.9 out of 5 stars 46 reviews

Breast lift

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the donut lift will accomplish very little for your goals.  It would be best to have a full lift our formed along with downsizing of implants.  That will not only give you the lift you need, but also enable reduction of the areola.  The donut oft sounds like a good idea, but in reality, it is not  very good procedure at all, especially if you want smaller areolae.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

The right size for you

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It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon.

Donut Incision Along with Lift

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I prefer to  use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring. For women with moderate to severe breast sag, a breast lift (mastopexy) may be recommended to ensure the best result and longest lasting result. In your case you will be able to replace your implant with a smaller size and have the lift completed to help with the firmness, perkiness and shape of the breast. Failing to have a breast lift when necessary will only lead to a less than ideal result leaving the patient unhappy and needing a revision surgery. A larger breast implant can help lift the breast, but the low hanging breast tissue will still be present causing a disconnect between the implant and breast tissue located at the bottom of the breast.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Revision Augmentation Mastopexy

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Hello,That would not be possible. Your breasts are too big, and your areola to low. Performed well, your scars from a formal breast lift and reduction will be inconspicuous and leave you with superior shape compared to a surgery that could potentially deform you. Go visit a few ABPS certified/ASAPS member surgeons that specialize in revision breast surgery.Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Is it possible to do a donut breast lift with areola reduction and smaller implants on my breasts?

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Thank you for the question and picture. You seem to have a very clear idea of what you would like to achieve; in my opinion, this will be best accomplished with a full breast lift (small breast reduction) and downsizing of breast implants.  A circumareolar lift will not be "powerful" enough (and is frought with potential problems) to achieve your stated goals, in my opinion. 
Ultimately, careful selection of your surgeon and careful communication of your goals will be key. In my practice, this communication is best done with the help of visual aids such as goal photographs.

You may find the attached link helpful to you as you learn more.   Best wishes.

Reduction mastopexy/augmentation

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the areoles can be reduced and initially will look fine but after time they will also increase in size with the size of implant you want. I am curious why you want the natural breast tissue removed? Maybe instead of downsizing of implants you may just need a breast lift with removal of your 900cc implants.

Susan Kaweski, MD
San Diego Plastic Surgeon

Downsizing implants and donut lift

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Hi and thank you for the question. It is certainly possible that you could achieve a nice result with implant downsizing and a lift. Based on your current nipple position you may do just fine with the donut lift only. As part of the donut lift your areolas can certainly be made smaller. You just need to share your ideal goal size with your surgeon. You also have some contour irregularity in the lower poles of your breasts that may be a result of capsular contracture. This should be addressed during your consultations and improved during your procedure. Good luck to you. Dr West

Justin West, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 30 reviews

When A Donut Lift Works Well, and When It Doesn't

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Thank you for your question regarding your desired breast changes.  If you are looking to exchange your implants and reduce your areola, the donut lift can work well.  The limitation of this type of lift, however, is that it does not reduce a significant amount of skin well and it does not lead to a very small areola after healing is fully complete.  When you greatly reduce the size of your implants (you suggest 300 to 400cc), there will be a significant amount of skin both in the vertical direction as well as side to side.  The donut lift can reduce some of this skin, but likely, not all of it.   To reduce a good amount of skin with this type of lift, a significant degree of tension is created in the areolar suture line.  This results in the areola stretching-out to a degree, even if a permanent suture is used.  i would recommend a vertical lift (lollipop) to better achieve your shape goals.  Best wishes!

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 34 reviews

Is it possible to do a donut breast lift with areola reduction and smaller implants on my breasts?

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Thanks for your question and photo.  I think you display some of the problems of trying to avoid a lift by placement of very very large implants at the time of your initial surgery.  I also see what appears to be implant herniation of some kind in your lower poles.  Remember also that very large implants (ie 500 and above) stretch your areolae and work against efforts to narrow them.Meet with an ABPS BD Certified plastic surgeon to be examined and counseled on your options and choices.  I think you should consider a vertical or short horizontal scar full mastopexy with change to implants in a 400-500 cc range.  This advice is only based on your photo and needs confirmation of a face to face consultation.  Good luck and best wishes.

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 32 reviews

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