Areola revision after stretching: I had an areola reduction two years ago. (Photo)

Question

The areolas have completely stretched out again, and the scar and asymmetry make them even more embarrassing than before. The skin of my areola is very delicate and thin, so I fear that they'll always stretch out, even if I re-do the surgery. Can I get the areola removed entirely, and have my regular skin attached to my nipple? That way they wouldn't stretch out, and i could tattoo my areola on. I would love to feel confident naked.

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question and the photographs.I am sorry to read of the concerns you are having. It would be useful to see your surgeon again to discuss this and find out what he used to stitch th ewound. Sometimes the absorbale stitches dont hold long enough fo rthe scarring to develop to prevent the stretch and it might be that he needs to consider using a permanent stitch. This usually helps prevent further stretch. MY colleague Mr Rohit Seth and myself carry out these procedures regularly and have on occasion had to reduce the areola as it can stretch again. What size were your areola to begin with ? If they were very large, then the areolas sometimes do need a second stage or revision to reduce them following the stretch so this will not necessarily stretch again. If you consider the areola size to be the diameter of a mango and you are reducing this to the size of a walnut - there will be quite a lot of tension and this can stretch it back slightly. If it does stretch and is now the size of an apple - then reducing this to the size of a walnut is easier as the tension will be less. ( forgive the fruit analogy !!) There is a possibility of removing the areola completely but the concern here is that you will then have stretch at the base of your nipple whihc can pull this inwards and make it inverted. My advice would be to consider revision surgery and maybe as a staged procedure - if your surgeon measures out the areola diameters then aims to reduce it in two stages this may reduce the tension on the scar and lessen the stretch. The other option is to do this and use permanent stitches in the second stage . I hope this is of help to you.KR

S. Larry Schlesinger, MD, FACS · Answer

Your first course of action should be to contact your original plastic surgeon and be sure that he or she might not have a newer technique for a secondary areola reduction.  That being said, if you were my patient and there was sufficient laxity of the breast itself to allow a secondary areola reduction surgery, I would utilize a modification of Louis Benelli's original round block technique whereby tension is taken off the suture line with several in-depth circumferential reductions, suturing the tissue in the SFS.  This decreases the chance of stretching.  Then I would place a permanent suture which goes around the newly reduced areola, often called the Benelli suture, which keeps the areola from spreading until sufficient scar tissue has taken over.  All the above means you will need an expert plastic surgeon well trained in nipple reductions when attempting a secondary surgery in this very complex area.

Matthew C. Camp, MD · Answer

It seems likely that your original surgeon used an dissolving suture, resulting in the correction losing strength over time. Areola reductions generate a high amount of tension in the skin, requiring permanent sutures to correct. I would not advise completely removing the areolae, as this will likely generate more scar and result in an even worse outcome. Give your original surgeon a chance to fix the issue. Make sure he is a board certified plastic surgeon. Good luck!
Matthew C. Camp M.D.

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