Breast Reduction with Areolar Incision: What Was the Drawback?

One of the major concerns when considering breast reduction surgery is the long scar.

Even if people genuinely want the surgery, some are unable to proceed easily because of this scar.

Of course, the concerns vary somewhat by age group. In the 50s and 60s, many patients have already experienced long-term stress from having large breasts, so they often say they do not care about the scar and just want them made smaller.

However, most people in their 20s and 30s tend to be sensitive about scar-related issues, so they often prefer methods that leave shorter, less noticeable scars.

So, I prepared an introduction to methods that people considering breast reduction surgery have probably heard about at least once and may have considered.

Today, as the first topic, let’s talk about the areolar incision method and the crescent incision method, which leave the shortest scars.

Areolar incision method

The earliest report on the areolar incision method began with Dr. Hinderer’s paper in 1968. Because people abroad were also highly interested in scar-related issues after reduction surgery, efforts to reduce the breast through the smallest possible incisions have continued.

Among them, Dr. Benelli’s paper reported in 1990 was cited the most, which is why the name of today’s topic, the areolar incision method, is also known as Benelli concentric mastopexy.

There is also a slightly modified version of this method called the crescent incision method.

Crescent incision method

The crescent incision method was introduced by Dr. Shumway. Rather than cutting around the entire areola, it can be described as a method of lifting or reducing the breast by incising only the upper half of the areolar circumference.

This surgical method refers to removing tissue around the areola in a donut or crescent shape to reduce breast size, then removing the glandular tissue through this incision and moving the areola upward.

Among the scars from reduction surgery, the scar around the areola is relatively less noticeable.

Because the scar is located at the boundary between dark skin and light skin, it tends to be less visible than a vertical scar or an inframammary scar.

Therefore, if only the scar around the areola remains and there is no vertical scar or inframammary scar, the areolar incision method can be considered quite advantageous from a scar perspective.

However, this surgical method has several disadvantages.

First, it is difficult to correct large breasts. This is because it was originally designed to correct only mild ptosis.

Another drawback is that this process does not remove the lower tissue of the breast that has sagged, so the overall breast shape after surgery becomes flat rather than full.

Scars around the areola are also prone to developing atrophic scars or hypertrophic scars, which are among the main side effects.

If the nipple position is normal, there is no sagging, and the size is up to about full C cup, this areolar incision method may be used. However, even when such cases are carefully selected and operated on, there is still often the disappointment that the shape becomes flat rather than full.

So, I do not particularly recommend this surgery itself, and the reason is that there are additional issues beyond the side effects mentioned earlier.

This is not exactly a side effect, but it is an important aesthetic issue.

That is because the diameter of the areola can become significantly enlarged after surgery.

So many people undergo surgery focusing only on the short scar, only to later find that the areola has widened considerably and then seek consultation for revision surgery.

The shape of the areola may be maintained temporarily, but as time passes, it can no longer withstand the tension around it and begins to widen. The normal size of the areola is about 4–5 cm, but after the areolar incision method, it usually becomes 7–8 cm, and in severe cases, the areola may take up half of the breast.

This is because the areola and the surrounding skin have different characteristics.

The areola has greater elasticity than ordinary skin, so it is a tissue that stretches more easily. When the surrounding skin is removed and the area is gathered and sutured around the areola, the surrounding skin does not narrow and heal; instead, the more stretchable areolar tissue expands to fill the amount of skin that was removed.

To prevent this, non-absorbable nylon thread or Gore-Tex thread is sometimes used to purse-string suture the surrounding skin.

Even then, it is ultimately difficult to maintain the pulling force deep in the tissue, and over time the areola eventually changes into an excessively enlarged shape.

People who actually had their first surgery done with the areolar incision method and later decide on revision surgery consistently say that only the nipple position was raised, while the size and sagging were not improved much.

For this reason, revision surgery involves reducing the overall volume more and at the same time making the widened areolar diameter smaller again.

The biggest challenge in such cases is securing blood flow to the nipple.

After surgery with the areolar incision method, the blood vessels around the nipple are severed while being encircled, so before revision surgery, it is necessary to check which vessels remain around the nipple.

Depending on the results of this examination, an appropriate surgical method must be chosen in order to perform revision surgery safely without the complication of nipple necrosis.

This can also be checked with Doppler ultrasound. Because Doppler examination can determine not only whether blood vessels are present but also the strength of blood flow in the remaining vessels, it is a useful test before revision surgery.

The areolar incision method has the advantage of leaving a smaller scar, but you must only proceed in suitable cases to achieve the desired result, so please make a careful decision after a thorough consultation with a specialist.