Plastic Surgery Case Study: Breast Implants with Periareolar Lift

Background: Loss of breast volume is very common amongst women usually caused by pregnancies or weight loss. As the breast deflates sagging of the breast mound often occurs. As long as the nipple remains positioned at or above the inframammary fold (lower breast crease) augmentation with breast implants will adequately fill up and out the deflated breast creating a more pleasing breast size and shape.
But with increased degrees of breast sagging (nipple at or below the inframammary fold), an inplant alone will not be satisfactory solution. While it will expand the breast volume the nipple will likely be driven downward not upward creating a breast look that few would desire or accept as an improved breast shape outcome.
The need for a breast lift at the time of breast augmentation is very common. While no woman wants a breast lift and the skin scars that result they may have little choice. The options for true breast lifting are three fold. The most common and effective are the vertical breast lift (lollipop lift) and the combined vertical and horizontal breast lift. (anchor lift) But the breast lift that creates the least scar and also has the least lifting benefit is that of the periareolar or donut pattern breast lift.
Case Study: This 42 year-old female presented for breast augmentation. She had lost some weight, and between that and having had children, had a bit of a breast sag. Her nipples were exactly at the level of the inframammary fold. The dilemma was whether just getting breast implants would create a nipple positioning problem on the enlarged mound or whether she should just have a breast lift at the time of her implants. She was adamantly opposed to any type of breast skin scar on the mound itself.
Under general anesthesia she had silicone gel breast implants (475cc) placed in a dual plane position through a small inframammary incision. At the same time she had an eccentric ring of skin removed from around her areolas. (donut breast lift)
At three months after surgery, her breasts show an acceptable breast mound enlargement and nipples that were in good orientation on the breast mound. There was no appreciable sag of the breasts although her breast mounds remained in the same overall position as that before surgery. Her areolar diameters were increased.
Of all the types of breast lifts, the donut lift is the ‘weakest’ of the group. It really has a very limited breast lifting effect and this could be seen if it was ever just done on its own. It does provide a bit of a lift when combined with implants although the implants really do the heavy lifting in the final result. But the donut lift does have a role to play in the woman who is questionable if she really needs a lift or not. It may be just enough in some women to allow them to get by without having to get scars on the skin portion of the breast mound. It is hard to say whether the increase in areolar diameter seen is due to the natural stretch of it from the underlying implant expansion or from the combined tension of the periareolar skin reduction.
Highlights:
1) Minimal to modest amounts of breast sagging can be improved with a perirareolar or donut style breast lift procedure.
2) A periareolar breast lift works best when combined with breast implants.
3) A periareolar breast lift almost always enlarges the diameter of the areola, particularly when used in combination with breast implants.
Dr. Barry Eppley
Indianapolis, Indiana