A periareolar mastopexy, which is also called a purse string, doughnut (donut) or circumareolar mastopexy, is a technique used for breast lifts that employs just one incision which is situated around the areola. It is inherently attractive to many women who are seeking to rejuvenate and lift their breasts with few tell-tale signs. I feel strongly that a periareolar mastopexy is a rarely indicated approach except for very rare situations involving very minor drooping. The tradeoffs are too high a price to pay in comparison to the far superior results that can be obtained with more and longer incisions.

Unfortunately, many people including physicians have a tendency to equate shorter scars with better, more advanced or state of the art results as well as a more talented surgeon. In situations where the results are exactly the same irrelevant of incision length, such as in gall bladder surgery, this belief can be well founded. However, this isn’t valid in breast lift surgery where I have always believed that if more or longer incisions would allow for an unequivocally superior contour and appearance, then the trade off would be worth it.

The goal of a mastopexy is to recreate a natural, conical shaped breast that has the areola situated at the most projecting part. An inverted-T (or anchor shaped) incision allows for the most precise reshaping of the breast and skin envelope in a three dimensional fashion. It also facilitates the accurate repositioning of the nipple-areola complex on the ideally recontoured and rejuvenated breast.

The limited incision periareolar mastopexy technique eliminates the vertical scar extending down from the areola as well as the horizontal scar in the breast fold. Therefore, essentially a two dimensional approach is expected to solve a three dimensional problem involving lifting and reshaping the breasts, resizing and repositioning the areolas and attempting to obtain improved symmetry. This all has to be performed with the asymmetric removal of a doughnut of excess skin from around the areola and then and purse stringing the larger circle to the smaller circle (areola) which tightens the skin.

This technique creates maximum tension around the areola which then translates into significant untoward and predictable consequences including:
1.)    flattening of the shape of the breast yielding more of a pancake contour rather than a conical one
2.)    a stretched and often flattened areola causing that can be irregular in shape
3.)    widened and thickened scars around the areola
4.)    the appearance of  skin pleats and lines emanating radially outward from the areola
5.)    limited flexibility in the precise placement of the areola on the breast mound
6.)    difficulty obtaining better symmetry of the breasts particularly when they were significantly different in size and or shape prior to surgery

A quite convincing illustration of these issues can be seen in the photos below. This 36 year old woman had a periareolar mastopexy performed by another plastic surgeon and was very unhappy with the outcome on several accounts. She saw me in consultation in order seek correction of her suboptimal results.

This is the outcome of a periareolar mastopexy that was performed by another plastic surgeon. The scars around the areolas are very noticeable, wide and unacceptable. A pleating effect - lines in the skin radiating outwards from the areola - can also be seen.

The scars resulting from the donut mastopexy are prominently visible. The flattening of the areolas as a consequence of the purse string technique is well illustrated in the right breast. Instead of the breasts being perky and somewhat conically shaped, they are flattened and underprojecting.

Very wide and unacceptable scar on the left breast from the periareolar mastopexy

For additional information on breast lift surgery with or without a concomitant breast augmentation or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Though the overriding goals in breast reduction surgery are to adequately decrease the sizes of the breasts and to obtain reasonable contours after doing so, the final appearances of the nipple-areola complexes also rate high. With everything else being equal, the nipples have a much better likelihood of retaining their aesthetic characteristics if they are not detached from their blood supply, ducts and underlying tissue.

However, in women with extremely massive breasts, this may not be possible if a free nipple graft breast reduction procedure is selected. This technique does provide for the most predictable and aesthetic outcome including size but does necessitate the removal and then replacement of the nipple-areola complexes as skin grafts. Consequently, there will be some deterioration of its structure and appearance.

What are the most common sequelae that are seen? The projection of the nipple usually is minimal and there may only be an outline of its location. The areola itself is thinner and not domal shaped. In darker complected women, there can be partial loss of pigmentation yielding a variegated pattern that may be either temporary or permanent.

One such example of the appearance of a nipple-areola complex following a free nipple graft reduction mammoplasty can be seen below. Pigmentation has been maintained as has some of the projection of the nipple. This result should not be considered to be representative of all outcomes with this procedure.

Example of the appearance of the nipple-areola complexes following a free nipple graft breast reduction.

For more information on breast reduction surgery or on any other plastic surgery procedure that I perform or to schedule a complimentary cosmetic consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Women with naturally large breasts frequently experience several common and uncomfortable symptoms and physical findings. These may include pains in the shoulder, neck and back, fatigue, indentation and irritation of the shoulders, headaches, rashes, skin irritation and infections, numbness of the hands, arthritis of the neck and/or lower back, postural changes and even discomfort sleeping on their back. Fortunately, breast reduction surgery is virtually always quite successful in alleviating the symptoms associated with enlarged breasts though some physical changes may be permanent.

A vast majority of the patients that see me in consultation for breast reduction surgery exhibit indentations of their shoulders as a consequence of the weight of their breasts causing their bra straps to dig into their shoulders. The more massive the breasts and the longer a woman waits to undergo a breast reduction, the deeper these grooves may be.

In the photos below of a patient who saw me in consultation for breast reduction surgery, you can see the prominent indentations of the shoulders. Interestingly enough, the deeper groove is situated on the right, the same side as the much larger breast. These invariably persist even long term after successful surgery.

Woman with shoulder indentations seeking breast reduction surgery. The deeper groove on the right is also associated with the larger right breast.

Right shoulder. Deeper indentation here associated with the larger right breast.

Left shoulder. Indentation here is not as deep due to a smaller breast on this side.

If you would like to obtain more information on breast reduction surgery or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona