Different sized areolas post unilateral breast reduction

Question

I am F, 24, 160lbs. I recieved a unilateral breast reduction with a lift. I had extreme asymmetry. The right breast was a D cup with lots of loose, sagging skin. The smaller breast was a B cup. After the surgery I am left with significantly different areola sizes. The areola on the larger breast is very small and round. On the smaller breast the areola is larger, and more oval-shaped. I don't understand how this happened. Surely this could have been avoided? Please help

Mark McRae, MD · Answer

Breast and areola asymmetry following unilateral breast reduction is a common concern for many women who have undergone this procedure. While breast reduction surgery aims to improve breast symmetry and proportion, it's important to understand that achieving perfect symmetry is not always possible.

In your particular case are you overall more symmetric in terms of your breast volume, breast shape, and nipple position? 
When repositioning the nipple, a smaller areola is most often created. There are a range of sizes so you and your surgeon have some choice, but depending on the size you started with, a smaller size more likely. In a bilateral procedure the smaller areola is in most cases more aesthetic. Unfortunately when only one breast is operated on, this can result in areola assymetry.

The good news is that the areola size of your smaller breast can be made smaller, and repositioned if needed to further improve your symmetry. Some changes in breast shape can also be achieved if needed. 
Make sure you discuss this with a board certified plastic surgeon and take the time to make sure all your questions are answered before proceeding.

Elizabeth Kiwanuka, MD, PhD · Answer

I'm sorry to hear about your experience with significant differences in areola size and shape following your unilateral breast reduction with a lift. It's understandable that you're feeling concerned and confused about why this occurred.
While breast asymmetry is common and often addressed through breast reduction surgery, achieving symmetry in areola size and shape can be more challenging. Areola size and shape can be influenced by various factors, including the amount of breast tissue removed, the extent of the lift, and individual variations in tissue elasticity and healing.
During breast surgery, surgeons typically aim to create as much symmetry as possible between the breasts, including the size and shape of the areolas. However, achieving perfect symmetry is not always possible, particularly when starting with significant differences in breast size and shape.
It's important to discuss your concerns with your surgeon to understand why this outcome occurred and what options may be available for addressing it. Depending on the extent of the asymmetry and your goals, potential solutions may include additional surgical revisions, areola tattooing to improve symmetry, or other non-surgical techniques.
Your surgeon can assess your individual situation and work with you to develop a plan to address your concerns and achieve the best possible outcome. Open communication and collaboration with your healthcare team are key to finding a solution that meets your needs and helps you feel more comfortable and confident in your appearance.

Connie Hiers, MD, FACS · Answer

Areolae can shrink and expand. However, this can be fixed. Please go back to your surgeon and discuss your concerns.

Camille Cash, MD · Answer

If you are less than six months from surgery you will want to wait longer to heal to see the final result.  If you are still unhappy at that time you can consider a revision to bring the asymmetry into better proportion.  Visit with your board certified plastic surgeon to learn more.

Mats Hagstrom, MD (license on probation) · Answer

To begin to make an assessment regarding the outcome of any plastic surgery procedure we generally always need to see a complete set of proper before and after pictures.
If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
Try reposting with pictures.
If you had significant asymmetry before the procedure, then there’s a good chance. You may have some asymmetry after the procedure as well. If your breast were drastically different inside, then, perhaps your surgeon used to different types of surgery on each breast, and this can influence the outcome, including Ariola size
Why don’t you follow up with your plastic surgeon and discuss your concerns with him or her.
Maybe they can do a revision.
Best,
Matt Hagstrom, MD

Heather Pena, MD - Account Suspended · Answer

Given the degree of asymmetry you had preoperatively, you may have something called tuberous breast deformity with protrusion of some of the breast tissue into the areola. This can be difficult to correct. It is hard to make an accurate diagnosis without photos. It is also hard to say if it could have been avoided, as scars will heal differently and there are many factors that contribute to that healing.

Different sized areolas post unilateral breast reduction

Answers (6)

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