Why I rarely perform periareolar (donut) breast lifts anymore

Posted July 01, 2020 in Breast Lift

After 25 years as a plastic surgeon, I have a much better sense of what does and does not work on a long term basis. Early in my practice, I performed numerous breast augmentations in conjunction with periareolar mastopexies (translation: donut lifts). In a traditional periareolar or cirumareolar mastopexy, a “donut” of skin is removed around the periphery of the areola (pigmented skin surrounding the nipple), and a permanent suture is used to tighten the surrounding skin down to the new smaller nipple areola. Think of a drawstring purse (or if you’re a guy reading this: a hefty cinch sack). This technique is highly successful in enlarging the breasts while simultaneous reducing the diameter of areola—for a while. The problem is that the areola and breast cannot be permanently molded by a single suture just under the skin around the areola. Eventually the tissues erode through the suture, usually over the course of a few years, causing the following:

1. The areola re-widens (often to an even greater diameter than before surgery).
2. The scar widens and becomes irregular and scalloped (due to the tension on the pursestring suture).
3. The breast falls (because one suture will not hold up the weight of the breast), resuming its preoperative position.

So what do I do instead? A circumvertical mastopexy (lollipop lift). In addition to the periareolar incision, this technique requires a vertical incision along the lower portion of the breast (making the combined incisions the shape of a lollipop). There is no question that the additional incision is a downside, though most of it is hidden on the underside of the breast. On the upside:

1. The areola can be reduced with the anticipation that it will never re-widen. Why? All of the tension is placed on the vertical incision and not the periareolar incision.
2. The periareolar scar will remain narrow (for the same reason).
3. The breast will remain lifted (because the lift is being accomplished through narrowing and reshaping of the lower breast, not by a suture around the areola. So there is no need for a permanent periareolar suture that can become irritated or infected.

Before

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8 Months

Before

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8 Months

I perform periareolar lifts in fewer than 5% of our breast lift patients. They are occasionally useful. But for the vast majority of women, a circumvertical lift provides a far better long term surgical outcome.

Click here for more information about breast implants with mastopexy by Dr. Friedman.