What is the Truth About the Benelli Lift/areola Reduction? Does It Make Areola Stretch More?

The problem is that in women who truly need a vertical or full mastopexy, but refuse to have the incisions that these operations require, we as surgeons tend to compromise and subsequently will push the limits of this operation. When we as surgeons try to push the limitations of an operation like the Benelli lift, a number of problems can occur, such as stretching or spreading of the areolar complex.

The reason for that there is no general consensus with respect to Benelli Mastopexy, is that there is commonly a misunderstanding between patients and their surgeons about what this particular operation can achieve. There are many types of breast lift operations available, however several of them require an incision be placed either on the front of the breast, in the inframammary fold, or both. Many patients that I see would prefer to avoid these incisions, choosing to have circumareolar (aka Benelli) lift incisions instead. 

 

 

 

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The goal of every breast lift should be to 1) minimize length of scars, while 2) maximizing quality of scars and 3) maximizing breast shape.  For the ideal patient, a periareolar lift is a fabulous operation.  However, trying to get too much lift out of a periareolar lift can leave a poor quality "purse-string" scar and a flattened breast shape.  

In my hands, the ideal candidate for a periareolar scar approach has slightly "cone shaped" breasts that can be flattened a little without negative consequences and requires only a couple of centimeters of nipple elevation.

You WILL get differing views about the Benelli lift, but certain issues are clear.  If the breasts are very low, a Benelli won't work and you need a full or T anchor mastopexy, to decrease the amount of skin while lifting the breast tissue, making a new skin brassiere and repositioning the nipple/areolar.  The Benelli lift does flatten the front of the breast.  To prevent areolar widening a permanent suture must be placed around the areolar and it depends on the patients skin quality and thickness whether this is visible or can be felt under the skin.  This suture can become exposed, infected and need removal, leading to lose of the support it was supposed to provide.  An anchor lift will reliably give an excellent lift and shape to the breast, without the need for permanent sutures and deforming the front of the breast.

Benelli described a periareolar breast lift technique that bears his name, yet many surgeons perform some sort of periareolar lift that differs from the details Benelli himself describes. In other words, some surgeons do a slightly different lift technique, and also use different suture materials, each of which can have a bearing on the answers you are receiving. Every surgeon who DOES something different will be truthful in SAYING something different.

Here's the skinny: If a premanent suture is used (like Benelli described), there will be less (theoretically none) areolar stretch, since the suture does not stretch or dissolve. Obviously, there are still limitations to the amount of "lift" that can be achieved with this procedure, and the net result is usually some degree of areolar flattening, as well as some degree of scar irregularity dependent upon how large of a circle is "purse-stringed" to a small(er) diameter areolar circle (Hence, the minimal degree of lift possible).

To avoid the visible suture (which can sometimes be FELT as well), some plastic surgeons have used other suture materials. Disssolving sutures lose their ability to "block" the areolar stretch that always occurs without a permanent suture, so some surgeons choose a very long-acting dissolving suture like PDS, hoping that the healing and stability of the suture line is established if the stitch is present for "long enough." I have tried this, and it generally doesn't work. Shorter-acting dissolving sutures are even quicker to allow areolar stretch, which is not only faster but more severe!

So most of us who still perform Benelli or modified periareolar lifts in select patients will use some sort of permanent suture to avoid the stretch, but unfortunately which can be seen or felt in some patients. I have found the best compromise between these opposing issues is satisfied by use of a Goretex suture, which is a permanent suture, but one which is microscopically porous to allow tissue ingrowth and fixation, and yet soft and somewhat "stretchy," which decreases the visible and palpable suture presence after this kind of lift. This is further enhanced by trying to place the suture in the deep dermis and taking many small bites with the suture. Still, some patients have thin skin and the stitch may become visible, especially after swelling diminishes!

I presently perform few Benelli or periareolar breast lifts because I do not like choosing between these two not-so-desirable alternatives, and because if you are a candidate for a minimal lift, you might well be a candidate for no lift at all. If you really need a lift, then you may be better served by a "full" lift that truly shapes the skin brassiere and repositions the nipple/areola complex to its "proper" higher, lifted position. Best wishes!

Hello 7000xo,

The answer is 'it depends'. Unfortunately, the benelli mastopexy (lift) is the most frequently named surgery in medical malpractice cases for cosmetic breast surgery.  This is because surgeons use this lift in patients that are not good candidates, and are best suited for a vertical or full anchor mastopexy. Kinda scary to think that so many doctors don't know what they're doing, huh?  So, there are not just cases of re-expansion of the areola after this lift, but also severe pleating of the skin, flattening of the breast mound, persistent sagging of the breast, and thickened scars. 

Having said all that, I believe the Benelli mastopexy is an excellent technique for the right individual.  When properly applied, the areola are smaller, scaring is inconspicuous, and breast shape is excellent.

What you need to do is seek out a real expert in breast surgery, and preferably revision breast surgery.  These individuals are not likely the surgeons that churn out breast augmentation after breast augmentation. Those individuals are just the lowest priced guys in town, or the ones with the best PR.  You want a thoughtful, well credentialled individual who can not only perform a breast augmentation, but also repair complex implant/breast problems and perform full reduction and lifts.  Why?  Because if you are not a good candidate for a benelli lift they won't tell you that you are just because that's the only procedure they can perform other than breast augmentation.   Certification with the ABPS and membership with the ASAPS is just the baseline, but a manditory requirement.

Best of luck!

A word of caution: many surgeons perform what they call a 'circumareolar' (or 'donut' or 'Benelli' ) mastopexy. In my opinion there is absolutely no such thing as a 'circumareolar mastopexy'. Removing skin around the areola may enable a surgeon to elevate the position of the nipple/areola complex perhaps 1-2 cm on the breast mound, but it DOES NOT lift the breast itself. In most cases, unfortunately, it serves to distort the shape of the breasts, making them appear flattened at the top. If the breast needs to be lifted, it absolutely requires some internal rearrangement of breast tissue to create a projecting, aesthetically ideal and lasting result - which in turn requires that vertical incision and vertical surgical scar below the areola (and sometimes in the inframammary fold as well.

For several years I have been using a 'vertical scar' technique for most breast reductions, which eliminates the long, horizontal incision in the inframammary fold below the breasts. I have also adapted this technique for breast lift surgery, and have been extremely pleased with the results. As with breast reduction patients, this new technique not only eliminates the horizontal incision, but also creates more impressive breast projection and maintains it better over time. The breast lift procedure I perform not only removes breast skin but also moves some lower pole breast tissue to a higher position, increasing the projection of the nipple/areola area.

Breast lift surgery works well for patients with enough existing breast tissue to build a projecting 'breast mound'. However, in most breast lift Raleigh / Durham patients it is difficult to create sustainable fullness in the upper poles of the breasts by means of a mastopexy alone. This is particularly true in patients who have experienced significant deflation following pregnancy and lactation. For patients who indicate that they wish to achieve a fair amount of fullness in the cleavage area as a result of their breast lift surgery, I recommend that they undergo augmentation mastopexy. This surgery combines a breast lift with the placement of a breast implant usually of modest size, which produces the most youthful breast profile possible.

The circumareolar scar from the latest techniques using permanent sutures are excellent. The number of revisions per year in minimal and quite often the scars are better than from other types of reduction/lifts.

Benelli is only one of the earlier types of circumareolar lifts. In my practice, the Goes technique with and internal brassiere support is the best.

Key features;

1- internal brassiere with mesh for added durability.

2-Can lift breasts that have a nipple to sternal notch distance of less than 25cm - so the amount of sag that can be corrected is limited.

3-Patients with dense breasts/less fatty - usually younger do better with this technique.

4- Nipple is never removed from breast tissue, sensation is better.

5-Lift is mostly achieved by lifting from above, makes for a natural, durable result.

6- permanent suture around areola makes scar minimal.

Yes, scars can stretch after a Benilli Lift or Peri-areolar Mastopexy, however, I now use a permanent suture when performing this technique and my rate of revision has gone down dramatically for this procedure.   Since switching to permanent sutures I have maybe one a year that needs to be revised due to the areola stretching.  This is a wonderful technique if indicated for the right patient.

 

 

Intuitively and in practice, in my opinion, the Benelli approach is rarely prudent - sacrificing shape to minimize the total length of the scars. This is rarely a good trade off. The breast shape with this approach is more blunted and flat versus a more natural conical shape. Furthermore, there is either stretching of the areola with time and/or problems associated with the permanent sutures employed to prevent this from happening in the first place.

The “truth" about the Benelli  breast lift,  is that like any  that other procedure,  a variety of different outcomes are possible ( including spreading of the areola) depending on  factors such as appropriate patient selection, technique used, suture material used, skin elasticity concerns  etc.

In other words, if all of the above factors are “optimized",  the procedure will work well;  if not, it won't.

I hope this helps.