It Seemed Like a Good Idea at the Time…
If you search online for things that seem like a good idea but really aren’t, you’ll find people talking about dating a co-worker or ordering a second pitcher of margaritas on a Sunday evening. Our favorite true-life story comes from a friend whose son decided it would be fun to roll bowling balls down a steep hill toward a neighbor’s house.
When we’re talking with a patient about breast surgery in New York—breast reduction, breast lift or even breast augmentation procedures—we understand when they’re interested in learning about so-called “doughnut” incisions around the areolas. We talked with a female to male (FTM) transgender patient about the option just this morning—hiding scars in the border between breast skin and the areolas seemed like a good idea to him. It wasn’t.
Doughnut, or peri-areolar, incisions (with areolar skin removal) do work well in limited cases. There are two factors that must be in place: a strategy for protecting the nutrient supply to the nipple to prevent necrosis, and working with smaller sized breasts whose volume won’t cause the scar to spread as it heals. The fact, is, however, patients who are good candidates are limited in number.
Better Approaches for New York Breast Surgery
In cosmetic surgery, peri-areolar incisions are sometimes used in a procedure called a “doughnut mastopexy” (mastopexy meaning breast lift). When breasts sag with time, areolas often spread and patients want them reduced in size. The thinking is to cut a ring of skin from the areola and tighten up the breast by suturing breast skin to the smaller areola.
Unfortunately, unless the breasts are quite small, they put too much strain on the incisions. Patients tend to end up with wide scars and puckering, and it’s not unusual for the areolas to stretch out again. Some cosmetic surgeons still offer the doughnut mastopexy option—we almost never do.
Our New York FTM breast surgery patient was not a good candidate for doughnut incisions because he wanted all tissue removed from his droopy breasts—in effect, a double mastectomy. In cases like this one where there’ll be leftover skin, the best approach is usually larger incisions that allow us to effectively address gland and fat tissue and remove skin. Then, the nipple needs to be moved carefully higher on the breast in a normal position. More scarring, yes, but the scars do fade in time. And the result is more predictable and natural.
This multi-incision/nipple graft technique is useful for other patients looking for surgery for large droopy breasts. We have used it with great success for guys with good sized man boobs, women with very large and/or very saggy breasts and female and male weight loss patients.
For many women seeking breast reduction and breast lift surgery in New York with us, we can use an incision partway around the areola and down toward the breast fold, the so-called “lollipop” incision, or down to the breast fold and underneath in an “inverted T” or “anchor” incision. This is a good compromise approach, preserving nipple integrity while allowing us to remove excess breast tissue and skin as needed, lifting the breast through incisions mostly hidden underneath.
A quick word about men with gynecomastia and wide areolas. We most often recommend removing excess tissue and allowing the areolas to shrink on their own. Many patients are surprised at how, when gland and fat are removed and the breasts become more normal in size, areolas follow suit.
Some Doughnuts are OK
We don’t mean to suggest that all areolar incisions are bad. Indeed, we use them at least weekly for guys with man boobs—usually at the base of the areola to pop out gland tissue. And we use them for women seeking breast augmentation in New York, when they choose modest sized implants placed over the muscle. Advantages do indeed include scars that are almost invisible, but note that we are not removing a circular ring of tissue around the areola in these operations.
There is one time when excising a doughnut of skin can be a good way to go. We do this on occasion for patients with tuberous breasts. It’s technically challenging, and a topic for next time!
Don’t worry if you’re confused about the right breast surgery. Contact us in New York and we will be happy to arrange a personal consultation. Together we can work out the best strategy for getting the results you’re looking for.
Photo by Anete Lusina from Pexels
