Staging Breast Lift and Augmentation to Avoid Stretched out Areolas?!

As the picture indicates, not only are my breasts sagging from fluctuating weight (which is under control now), but my areolas are the size of hubcaps! I want to get a lift plus and implant to regain my size, but I'm afraid of stretching out my areola because my skin is so loose--even if the circumference is trimmed during surgery. Would I decrease the chance of huge areolas by staging the procedures, getting the lift done first? -34C, never had kids, petite (5'9" 130lbs), super fit, South Asian/Indian

Doctor Answers 19

Why would you want an implant?

You already have C-cup breasts and judging from the photo, they are more than adequate in volume for your body. Just get the lift. It will last longer, the scars will be better, and it will sag less over time.

Remember, if you are saggy now with the existing weight of your breasts, then you will sag even more in the future if you add more weight to your breasts.

Los Angeles Plastic Surgeon
4.6 out of 5 stars 48 reviews

Staging breast lift and augmentation

By its very nature, a breast lift is a skin reduction procedure while a breast augmentation adds volume. This increase in volume places tension on the skin and scar. Anytime you place tension on a scar, there is a risk of scar widening.

While I agree with my colleagues that placement of a permanent suture may decrease this risk considerably, scar widening is still something to consider. If you went with the combo procedure of a "donut" lift/augmentation in one stage, going with a smaller implant may decrease your risk of scar widening because it creates less tension.

Personally, if i had a patient who was concerned about periareolar scar widening, I would offer this patient a staged procedure. In the first procedure, I would preform a vertical breast lift and in the second procedure, I would perform the breast augmentation

Hope this helps.

Andrew Jimerson, MD
Atlanta Plastic Surgeon
4.4 out of 5 stars 542 reviews

No benefit to staging implants plus lift

There is a lot of debate among plastic surgeons as to the merits ot doing a breast lift and augmentation in one stage or two, but stretching of the areolas isn't typically one of the issues.

The simple answer is that using a permanent stitch will prevent enlargement of the areola, but there is a trade-off. Under normal circumstances, the areola will expand and contract depending on temperature, stimulation, and so forth. A permanent stitch inside will prevent this too, so instead of expanding it pushes out in a "snoopy dog" shape.

Be sure to discuss all of the pros and cons of both the one or two stage procedure and the use of the permenent stich with your plastic surgeon, and it may be worth talking to more than one.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

No "normal" areolar size

Breast lifts are for ptotic breasts - they are defined as a nipple that is below the inframammary crease, although your breasts look slightly saggy, they are not truly ptotic. From the side view it appears as if your nipples are above the IM crease.

Secondly, there is no "normal" areolar size, they are usually fashioned to be between 4 - 5 cm in diameter after a reduction or lift, but some women's areolas are over 8cm in diameter and for them that is normal. Perhaps only an areolar reduction could be done to you.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Staging breast lift and augmentation to avoid stretched areolas?

Hello! Thank you for your question! These two procedures can safely and effectively be performed in one setting, given you are healthy and without medical comorbidities to prevent such. Staging the procedures to have them done at various times will likely not have any cost benefit for you. When you combine procedures, there is often a discount that is provided by the surgeon for multiple procedures. Also, when having multiple procedures performed at the same time, you save on anesthesia and facility fees, which otherwise are paid for with each individual procedure. In addition, you may benefit by the single recovery time.

However, more importantly than the financial aspect, your plastic surgeon will have to determine for you if the viability of the breast as well as nipple-areolar complex may be placed at jeopardy if done at the same time. If for this reason, it would be wise to stage these procedures.  Undue tension and stretch is what causes stretching of incisions/scars.  Use of a permanent suture around the areola may help.  Placement of an implant beneath the breast will impact issues such as this, but uncommon in my experience.

Certainly it is you decision as to whether you have your procedures performed in one or multiple stages, but your surgeon will give his/her recommendations. Consult with a plastic surgeon well-versed in breast surgery who will discuss and examine you, while assisting you to decide which procedure will be the best option for you. I would discuss your concerns with your surgeon and see what your options are - sometimes multiple consultations with board-certified plastic surgeons is helpful for you to decide. Hope that this helps! Best wishes for a wonderful result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Staging the breast lift and augmentation to avoid stretched areolas?

I don't believe an experienced aesthetic breast surgeon would need to stage your procedures.

While there is no assurance the final areolar diameter would be decreased following single or staged surgery, it very likely would.

Most importantly, patients are very pleased with the added fullness following augmentation and tend to be less concerned with areolar diameter.

Eric Pugash, MD
Vancouver Plastic Surgeon
4.9 out of 5 stars 136 reviews

Breast implants and breast lift should be done together.


They are not like hubcaps! Seriously, a well done simultaneous breast lift with breast implants will give you good shape and size and will permanently make your areolas smaller all in one stage.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Timing Breast Lift with Implants

Hi there-

Having done a very large number of aesthetic breast procedures, I would say that your chances of ending up happy and avoiding the problem you are concerned about are maximized NOT necessarily by staging the procedures you describe, but by altering the plan.

In my opinion, circumareolar breast lifting is only appropriate for women with either a very pointy central breast, or who have a very minor amount of excess skin and need only minor nipple relocation. With the techniques you are asking about, I think your chances of ending up disappointed are significant regardless of the timing...

Unfortunately, many women believe that all breast lift techniques are appropriate for all patients, and the choice of procedure should depend on your desired scar.... This is absolutely not the case.

Having selected a breast lift technique (in another office) based on the scar they wanted (or the scars they DIDN'T want) is the most common reason women end up in my office wanting another operation to correct their funny breast shape.

Having said all of that, I would need to examine you to be able to advise you responsibly, in order to measure the quantity and qualities of your skin and breast tissues, and better understand the excess, as well as your goals.

The take home message here is that you should concentrate on first finding a plastic surgeon certified by The American Board of Plastic Surgery who does a lot of breast surgery, THEN focus on effectively communicating to them your desired APPEARANCE, and THEN worry about the technique he/she recommends for you.

For more help on how best to locate a surgeon you like and can trust, read here:

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 157 reviews

Breast lift and augmentation staged procedure

You can undergo a staged procedure which might reduce the chance of the areolae stretching, but there's no guarantee of this. It's certainly possible to do a combined lift and augmentation through the areolae, at which time the areolae can be reduced to a size that is acceptable to you.

There may be some mild stretch with time, perhaps within a few millimeters. If this is accpetable, I would suggest just doing the procedures together. Keep in mind that if you do have children in the future, that your breasts will enlarge and the areolae will stretch. This may go down after your pregnancy, but the amount of change you might see is impossible to predict. I hope this helps, good luck.

Nina S. Naidu, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 13 reviews

Avoiding stretched out areolas

I love it when a patient "gets it"!!! You are right on in your decision from the scenario you have presented. Go see 3 boarded plastic surgeons in your area to show them what you have decided to see if they agree. Regards from MIAMI

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

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.