Breast Augmentation with peri-areolar Mastopexy - would a donut lift or lollipop lift be more beneficial for me? (Photo)

Dear Easygoing87308,

my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Breast lift with implants with a vertical scar will be better for you. Donut lift usually leaves widened scars.

You are a good candidate for a peri areolar lift. This has minimal scarring, but does not lift the breast a lot. If you want more shape to the breast with more lift, the vertical lift works better.

In my opinion, I do not think peri-areolar lift is a good procedure. If you truly need a lift, the a vertical (lollipop scar) lift is fundamentally a better lift. Putting the stress of the lift on the peri-areolar scar can lead to a widened and stretched scar. With a vertical type mastopexy, the stress of the lift is on the vertical scar and the nipple is carefully inset with no tension. I hope this helps.

While a side photo may confirm this, it appears that your nipples may be located below your breast fold. This would make a full breast lift suitable, rather than a donut lift (which would be insufficient).

I have seen too many donut lifts where the areolae stretched out and there was not adequate lift. Some surgeons opt for the donut lift because it’s easier to perform but the results are inferior to the lollipop lift

I apologize for not entirely answering your question, but my first advise to you would be to consider separating your breast augmentation from your areolar reduction/lift. It does seem enticing to get everything done in one surgery but it is very common to have recurring/widened areolas and widened scarring when trying to reduce while adding volume and stretching with an implant at the same time. For you best aesthetics outcome, choose your priority first and do that surgery. Followed by the second priority 6 mon-1yr following.

For small lifts, a donut mastopexy is perfect. This does allow minor repositioning of the areola, with movements of about 1 - 2 cm. The donut lift will also decrease the diameter of the areola. The problem with this approach is that it lacks the power to provide a significant boost to the breast tissue, and there is a risk of scar and areolar widening over time, especially when adding an implant. I prefer to use a lollipop incision because this allows for repositioning of the breast tissue and a more powerful lifting effect. The downside is that it adds an additional scar to the breast in a visible area, but does not have as big of a risk of areolar spread over time.

The decision of lift technique is a function the degree of necessary correction.

Patients with mild ptosis/sagging may benefit from a "donut" lift. This technique is reserved for a select group of patients whose degree of sagging is limited to a few centimeters. Inappropriate application of this technique can lead to disappointing results and areolar spread.

Patients with more significant ptosis will benefit from a lollipop or anchor lift which delivers a more robust correction albeit with a greater scar burden.

Based upon a single photo, it is difficult to offer any true guidance. That being said, if the droop is as significant as it seems in the photo a circumvertical/anchor lift is likely to be the most successful approach.

Ultimately, the best option is that which is recommended by your board certified plastic surgeon (ABPS).

Your breasts are very low on the chest wall and your areola are quite large. The breast lift technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.