Stretched Areolas After Benelli-- Is The Cause Not Enough Support Post Op?

Question

I had a Benelli mastopexy for my tuberous breasts (without BA) in December. I'm now 3 months post-op and my areolas are stretching out and beginning to take on their original shape, though only slightly thus far. I'm worried that it will continue to worsen. My surgeon never told me that I needed to wear a lot of support after surgery, so I didn't wear a bra for the first five days after the op, and never at night.Could this be at fault? Note: Scar is perfect, only the skin itself is stretching.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Wearing a support bra is unlikely the cause of the change in the size of the areola complexes.  Control of the size of the areola complex can be done very effectively with a t suture technique that "locks" the size of the areola complexes in place to minimize stretch.  The areola complexes may be reduced in size at a later date.  A detailed physical exam is needed to determine the possibility areolar reduction.

	Dr. ES

Michele A. Shermak, MD · Answer

It is not unusual to have this problem after Benelli mastopexy. I would guess your surgery may have been performed with absorbable sutures. When this occurs in my patients, I recommend revision with a permanent gortex suture that will hold the repair over the long term. This has worked very well. Your result is unlikely due to poor bra support - so don't worry that you missed something there!

Steven M. Lynch, MD · Answer

Hi,

	  It is diifficult to answer your questions without a picture but here are the facts of the donut pexy (Benelli lift).

	  The patient most often does not want a vertical scar on the breasts so the donut pexy becomes the least noticable approach to lift the nipple complex with two circles drawn on each areola.  The outer larger circle is around the areola and the recipient site for the areola.  The inner circle is the size of the areola size that is desired.  The tissue between both of these circles is now excised and the remaining nipple areola is raised to the new position and the tissue between is tucked inward as the two circles come together.

	  In so doing, especially with a very large movement, there can be a flattening of the breast.  This is because there is a push of the tissue as the circles are joined.  Sometimes this is noticablle but many times an acceptable tradeoff.

	  The areola spreading occurs because the forces on the incisions with the breast tissue being compressed will "drag" the borders of the areola outwardly from the center mark of the nipple bud.  There is no locking point that a vertical scar provides.

	  I am very specific with the areola spreading issue with the donut pexy for patients with tubular breasts. I show pictures of the spreading.  Some patients want to try to prevent it from happening and the vertical locking at 6 o'clock will help prevent it.  Some patients will accept the spreading.

	  Do not blame yourself for this occuring. Wearing a bra or not is not the key to it happening.  It just can happen.  As mentioned, the longer the distance between the original position of the areolas and the recipient place for the nipple complex, the more chance you will have for areola spreading. 

	   The spreading may continue.  Discuss your options with your plastic surgeon and come to a conclusion as to the approach to correct it.  In my practice, I suggest the vertical (I know, who wants it) incision to "lock" the circumference of the areola ( you will need the excess outer rim of the areolas removed to move to the normal size again).  Another step can be to place a permanent stitch in the tissue around the areola.  I find that it is difficult to get consistent accuracy of symmetry with this method.

	  Talk to your surgeon.  It can be corrected and perhaps more predictable for the future.

Tom J. Pousti, MD · Answer

I am sorry to hear about the complication that you are experiencing.  Unfortunately, the circumareolar incision is associated with the complication that you are experiencing; it is not necessarily related to use of supportive bras after surgery.  In my experience, the native breast skin elasticity (or lack there of) may be a contributing factor with recurrent areola spreading.

	Assuming that you are working with a well experienced, board certified plastic surgeon, I would suggest that you continue to follow up with him/her for follow up.

	Best Wishes.

Steven Wallach, MD · Answer

A Benelli lift is performed around the areola border. There is a yin/yang thing going on pulling by the areola one way and the skin around the border in the other way. I use a permanent sutures around the areola to limit the pull out so that the areola does not stretch too much. You shold ask your surgeon how he did his procedure and watch closely. The areola stretch can be revised.

Stretched Areolas After Benelli-- Is The Cause Not Enough Support Post Op?

Answers (6)