Areola stretch - does this indicate the need for an anchor pattern?

Question

I've had 2 LOLLIPOP lifts with different surgeons. Both times my areola stretched back out, my breast sagged again, and I rejected stitches. I'm going to need a 3rd lift. Does this indicate the need for an anchor pattern? Should I ask for permanent stitches since I'm prone to spitting dissolvable (which in turn has left me with widen scars around the areola)? Because of this I had them tattooed with a scar camouflage which made everything worse so I need to have that removed in the surgery.

Joel Patrick Maier, MD · Answer

It is hard to recommend what direction to pursue here. Depending on the size and shape and nipple position of your breasts, you may need a reduction to help remove the tissue burden. I find that performing breasts lifts without taking breast tissue leads to recurrent sagging, poor scars and an in-adequate job. Yes, this would involve the horizontal scar to achieve the proper result. A photo would be very helpful. Thank you!

Daniel Barrett, MD · Answer

Dear Ddrr123,

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

Gianfranco Frojo, MD · Answer

Yes, most patients are only candidates for anchor-pattern lifts as the horizontal resection is the only way to properly address the skin excess in the vertical (y-axis dimension). Lollipop lifts DO NOT have a horizontal resection and therefore place all of the tension on the vertical closure and around the areola while also not addressing the vertical excess of skin tissue of the breast.

John L. Burns Jr., MD · Answer

A vertical or lollipop lift places too much tension on the vertical incision resulting is a longer nipple to fold distance over time.  You should convert to a standard or Wise pattern.  In addition I'd suggest using mesh or internal bra to support the breast to prevent bottoming out.

Matthew S. Kilgo, MD · Answer

Hello. Thank you for your question. While it is difficult to specifically answer your question without photographs, areolar widening after a breast lift most often occurs with a circumareolar mastopexy, when the incision is limited to outside of the areola only. This type of breast lift requires permanent sutures to limit areolar stretch and it’s usually appropriate only for a minor breast lift. The addition of a vertical component in the lollipop incision usually reduces the tendency for areolar widening. Given your recurrent ptosis, you may benefit from a wise (anchor pattern) to provide a more effective lift but areolar stretch would not necessarily be significantly reduced when compared to a circumvertical mastopexy. If part of the areolar problem is hypertrophic scarring from spitting sutures, you may ask your surgeon to utilize a different type of absorbable suture. Good luck.

Robert M. Tornambe, MD · Answer

So sorry that you are having these issues but you do have options. It does sound like you need to revise your breast lift surgery utilizing anchor shaped scars. Since sagging of your breasts returned so soon after two operations, it may be a good idea to utilize a mesh during your revision to reinforce the lift. Come see me or another board certified plastic surgeon in our area to explore the best options for you. Good luck.

Gerald Minniti, MD, FACS · Answer

No pictures then no specific recommendations. In general, lollypop incision pattern lifts are not going to cut it for breasts with too much vertical skin excess, and they will need anchor incisions. Spitting sutures are usually surgeon dependent as no one 'rejects' sutures. Sutures that spit are contaminated with bacteria and infected; monofilament sutures are less apt to spit than woven suture (Monocryl or PDS are better than Vicryl), and the surgeon has to adequately bury each not to prevent a 'tail' from penetrating the epidermis, allowing bacteria to contaminate the suture knot. I grew up in your area but know no one I feel confident to refer you to.

Gary M. Horndeski, MD · Answer

There is an alternative technique I recommend called 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 if not injured during your previous surgery. I would need to see photographs to give you an accurate answer.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

The areola tissue can stretch due to the tension on incisions.  This can be related to several factors including large implants, genetics, etc.  An exam would be needed to give a specific recommendation to help you achieve the best results.

Bruce B. Kadz, MD, FACS · Answer

You will most likely be served with an inverted T (anchor) breast lift; areolar revision/reduction with exchange of implants into a smaller size

Areola stretch - does this indicate the need for an anchor pattern?

Answers (12)

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