Do We Have to Have Smaller Areolas?

I am contemplating a breast lift with reduction - I have a K cup breast - heavy and uncomfortable. I will obviously have to also get a reduction. The problem I have is scaring! I have a rare syndrome that I keloid after every cut. I have seen some womens nipples - after surgery - and I feel SO badly for them! Can I insists on keeping the areolas instead of having them cut all away - or use one of those nipple grafts? I - nor my partner - have a problem with large areolas or nipple areas!

Doctor Answers 8

Ultimate Breast Reduction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There is a new technique called The Ultimate Breast Reduction which allows women to decide what size breasts they want without having a vertical scar.  There are no lollipop or boat anchor shaped incisions required.  The areolas are not removed but are reduced to the desired size.  The other advantage of this technique is the breast weight is transferred to the underlying muscle providing pain relief.  I recommend this technique to you since you are concerned about the keloid formation and the areola scarring.

Best Wishes,

Gary Horndeski, M.D.

Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Do We Have to Have Smaller Areolas??

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I'm not sure I get the gist of your question. It is possible to leave the areolas at their current size. But if the question is "do I need an incision around the areola?" the answer will be yes. Not making the areolas smaller does not eliminate the need for an incision, since part of a lift/reduction involves moving the sagging areola to a more appropriate level, and that requires incisions, and thus scars. 

Best advice is to see a plastic surgeon in consultation. Your current scars can be examined and a discussion of the pros and cons, incision locations will ensue, and then you can make an informed choice. 

Thanks and best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Reducing keloid scars during breast surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If you are concerned about keloid scarring, there are several different options to minimize post surgical scarring and minimize recovery for breast reduction surgery and breast lift surgery.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Scars after breast surgery.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You will need an incision around your areola even if the size of the areola is not altered.  It's unusual for patients to scar really badly after breast reduction but I do have a couple of patients who did and they do not regret the surgery despite the scaring.  Scars are a tradeoff for a more comfortable and proportionate breast.  Only you can decide if the tradeoff is acceptable. 

There are some things that can be done early after surgery to help the scars behave.  If you were my patient, I would have you wear silicone pressure pads on the incisions for many months after surgery.

If and when you have a consultation, make sure you mention this issue to your plastic surgeon.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 77 reviews

Areola size

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

When performing a lift or reduction, most women prefer to have the areolae reduced to about an inch and a half  in diameter.  However, they can be made any size you wish and the diameter can be customized to your wishes.  You should be aware, however, that areolae tend to stretch with time and it is usually to err on making them a little smaller  than the size you ultimately want them to be.  Also, it it easier to make the areolae larger at a secondary surgery if you wish then trying to make them smaller.

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

Breast Reduction and Keloids

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Keloid scars can be very difficult to deal with.  However having K cup sized breasts can also cause serious problems.  I would reccomend consulting with a plastic surgeon in your area.  There are some techniques that can help prevent or limit the extent of keloids during your surgery.  While your areolas can be kept on the larger side, incisions will be required to have a breast reduction surgery.  Hope that helps, Dr. Kerr

Keloids and Breast Reduction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Regardless of whether your areolae are reduced or not, there will be a scar around them.  In order to lift the areolae, an incision needs to be placed around them to lift them.  If you reduce the size of the areolae,one could argue that the scar will actually be smaller as the circumference of the areolae will be reduced.  

If you do have a tendency to form keloids, you should discuss this at great length with a board certified plastic surgeon.  There are techniques/adjuncts that can be applied to help reduce keloid formation during your surgery.

With a K cup size and a tendency to keloid, a breast amputation and free nipple graft may be the way to go.  You would have to be examined to determine this, however.


Warmest Regards,

Asif Pirani, MD, FRCS(C)

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 35 reviews

Smaller Areola Necessary with Breast Reduction/Lifting?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for the question.

With breast reduction or lifting surgery the nipple/areola complexes are moved superiorly, just like the entire breast is moved superiorly. This movement of the nipple/areola complex is necessary to ensure that the nipple/areola complex ends up centered on the breast mound.

 In order to move the nipple/girl complex superiorly,  an incision is necessary around the nipple/areola. Therefore, even if your areola are not  reduced in size, an incision will likely   be necessary;  the resulting scar may be problematic for you ( given your history).

 You will likely be able to receive more precise information from in-person consultation with board-certified plastic surgeons.

Best wishes.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.