Breast Revision

Before And After Photos


This is a 37 year old mother of one, 5’7″ and 170 pounds who had a previous augmentation / breast lift and was not satisfied with her results (it was performed elsewhere). She complained of loose skin and large areola diameters. She had saline implants 350cc in volume beneath the muscle. The procedure was performed with an incision only around the areola on both sides (sometimes referred to as a “Benelli lift”). The resulting scars are only around the areolas (which sounds attractive to patients).

We discussed options at length. Certainly you can argue that her breasts are fine (albeit imperfect according to her). In this case I recommended that she consider a breast revision of her previous work (secondary breast work—it’s already been worked on). I suggested she change out her existing saline implants for the silicone variety and adjust the skin of the breast with a vertical lift and the removal of a modest amount of tissue along the bottom of the breast that “hangs” a bit. The resulting scar would be lollipop shaped and the areolas can be made smaller.

She is seen here about five years after her procedure. Our goals have been met (sort of). Her breasts are tighter (you can’t necessarily appreciate this in a photo), her areolas are certainly smaller, and her breasts look perkier to some degree. The “trade off” is the new vertical scar which, in her case is very good but slightly hyperpigmented (darker) because she has dark colored skin and this is not uncommon. She absolutely gloats about the difference between her former saline implants and her new silicone variety—”my breasts feel more natural, I don’t even know that I have implants”. “Many of my friends have asked to feel my breasts and they are shocked that they have been enhanced and they can’t tell that by feeling them”.

Learning points:

  1. Trying to “lift” a loose breast with an incision solely around the areola (Benelli Lift), is usually not successful. You can’t remove enough of the skin and the resulting scar around the areola usually spreads and the areola diameter gets bigger with time (basically you are asking the skin around the areola to do too much work).
  2. As I have said again and again, patients who have experienced both saline and silicone implants almost universally prefer the silicone variety.
  3. I used smaller implants the second time around. This is common and certainly educational. As women get older they often prefer smaller implants because it makes them less matronly looking, less heavy, less wide and more perky. Enjoy fuller implants when you are younger and change them for smaller when you get older, or love them all the way, or choose a moderate size to begin with and enjoy for life.
  4. The reason why she wasn’t completely satisfied with her original work is because her goals were not met because I’ll bet she chose to have the procedure done around the areola because there was less scarring. Indeed, there is less scarring, but her goals were unmet because it was impossible to achieve them without more scars.Is it better to get a little bit of the way with smaller scars or closer to all the way with more scars?If she was told this before her original procedure, do you think she would have chosen a lift only around the areola?