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Benelli Mastopexy - Peri-areolar Breast Lift
Benelli Mastopexy - Peri-areolar Breast Lift
(Doughnut, Donut Breast Lift, Concentric)
If you feel your breasts are sagging due to age, pregnancy,
weight gain or loss, but are afraid of the scar often associated
with more aggressive breast lift procedures, the peri-areolar
lift may be an option for you depending upon your level of
ptsosis (sag). A peri-areolar breast lift can be performed
with and without breast implants to reduce the amount of lax
breast skin and reduce the size of the areola (the colored disc
of skin around the nipple), if necessary.
What Causes Breast Sag?
Breast Sag is a result of several factors. The first being
the increase in breast size due to pregnancy, weight gain,
natural or unnatural hormonal changes, breast implants, or medications.
Secondly, the heaviness of a full breast can cause the tissue
envelope to thin and stretch. Thirdly, if proper support
is not worn, or natural aging further reduces the elasticity of
the breast envelope, superficial fascia and suspensory ligaments
(Cooper's ligaments). A fourth factor, gravity, takes its toll
and the breasts begin to sag. Women with medium to larger
breasts who often engage in sports which cause the breasts to
bounce (such as running, aerobics, and jumping rope) without
sufficient support are more prone to stress the ligaments and
skin envelope which in turn cause premature and significant
the Benelli (Peri-areolar) Breast Lift?
is the surgery of the breast that incorporates excision of excess skin
and re-suturing of the tissue to literally lift the breast by
making a tighter breast envelope and
give it a more youthful, perky appearance. The anchor incision was
once the only option and still may be your only option should you
have excessive ptosis (or sag) to lift your breasts to their
former appearance. Breast lifts can also incorporate tacking
of the tissue at the breast crease to raise the
natural crease which gives the appearance of the breast mound on a
higher position on the chest wall. You may have raised tissue around
areola which may or may not flatten in time. Puckering at the edge of
the areola is possible.
Only a qualified plastic
surgeon can assess your needs and discuss with you the options that you
may have involving a breast lift. Be sure that you consult with
several surgeons as not all doctors choose to offer their patients the
newest of options or any options for that matter.
Are You a Candidate
For Benelli (Pari-areolar) Breast Lift?
and foremost, an individual must be in good health, not have any active
diseases or pre-existing medical conditions which may inhibit wound
healing. You must also have realistic
expectations of the outcome of the surgery. Breast lift surgery is
not without scars and not everyone will scar as well as the next
patient. There are treatments which can lessen their appearance,
but the pre-existing disposition to scarring well is preferred.
This may depend upon your health, heredity, eating habits, if you smoke,
your post-operative protocol and your surgeon's ability.
You must also be mentally
and emotionally stable to undergo an cosmetic procedure. Cosmetic surgery is not
getting a cavity filled. This is an operation which requires patience and
mental stability in dealing with the healing period. There is sometimes a lull or
depression after surgery and if there is already a pre-existing emotional
problem, this low period can develop into a more serious issue. Please consider
this before committing to a procedure.
Once you have researched several surgeons, you will make consultation
appointments. The consultation appointment is ultimately
designed to interview the surgeon and discuss, in his/her opinion, what
your options are. Not all surgeons are going to offer the same
techniques, have the same opinions, nor have the same aesthetic
preferences. It is usually best to get at least 3 opinions.
appointment you should bring a list of questions you have prepared
to ask the surgeon, photos of what you like or do not like, and discuss
any concerns you may have.
Communication is crucial in reaching one's goals. You must be able
to voice your desires to your surgeon if he/she is to understand what your
desired results may be. Discuss your goals with your surgeon so that
you may reach an understanding with what can realistically be achieved.
If you are planning to still have children it is a good idea to wait until
you no longer wish to have any additional children. The skin may
naturally stretch and then sag again after pregnancy.
The physical examination will include
determining the laxity of the skin and degree of ptosis of the breasts.
Determining your grade of ptosis can be done at home in advance if you are
curious. This can be done by placing a ruler under the breasts at
the natural breast fold, called the infra-mammary fold. The top edge
of the ruler should be at the junction of the breast where it meets the
click graphic for the full
Grade 1 (Mild Ptosis): The
nipple is at the same level of the mammary fold, or slightly above the top
of the ruler, and is still above the lower pole of the breast.
Grade 2 (Moderate Ptosis): The
nipple is 1 to 3 cm below the top edge of the ruler and still above the
lower pole of the breast.
Grade 3 (Severe Ptosis):
The nipple is 3 cm or lower than the top of the ruler, it is a possibility
that you may have Grade 3 ptosis.
The nipple is still above the top edge of the ruler, but your breasts
appear as if they are sagging due to a prominent, (and sometimes
flattened) breast lobe.
You will also discuss the type of anesthesia that
your surgeon prefers for the breast lift procedure. Most
breast lift procedures are performed under either General or Light Sleep
Sedation. If you do go under General, ascertain that the anesthesiologist is certified
and that you divulge all of the medications that you presently take to
both the surgeon and your anesthesiologist. Please
read the All About Anesthesia Page. The risks regarding anesthesia
should be considered for a fully informed choice.
You may or may
not choose to book a surgery with this surgeon at this time.
If you do, you will more than likely be expected to place down a deposit to hold your surgery date.
You will then usually make an appointment for your pre-operative appointment
and make arrangements for preliminary blood tests and other lab work.
Benelli Lift (concentric, or peri-areolar, donut or doughnut lift)
is considered less invasive and was designed with the incisions being
made around the areolae (or areolas). With the Benelli, a
doughnut shaped piece of
tissue around the areola border (or includes areolar tissue as well
to reduce its size) is removed and the surrounding
tissue sutured to the areola. The incisions are sometimes closed with
permanent purse string sutures. The Benelli lift results in flatter
projection, yet a rounder
breast shape post-operatively as opposed to a naturally sloped breast.
Having had a Benelli lift, I feel that my breast projection did
decrease, but I do not feel that my overall breast shape was made to
round. In fact, I wish it had.
The scars are only
around the areola complex and may be darkened with the use of
micropigmentation. My scars
are light, but this does not detract away from the appearance of the
breast. There is also slight puckering present, which would be
solved by the insertion of breast implants.
Breast Lift Techniques
Lift (Diagram 1): This
technique involves removing a crescent-shaped piece of tissue above
the areola and resuturing the tissue higher. This creates a minor
lift for patients who have slight ptosis. The areola skin is
thinner than the surrounding tissue, so slight distortion at the top
is possible if proper support is not worn, or with natural sag and
aging. This can cause the areola to appear oval or egg-shaped
as a result.
The Benelli Lollipop,
or simply Lollipop (or Keyhole, Diagram 3):
This lift is the same as
the above but with the addition of a straight scar from under the areolae to the
mammary fold (crease). This is for those who have medium ptosis,
too much for the Benelli only and too little for a full anchor
incision. Although some surgeons are capable of giving good
results with the peri-areolar lift only for medium ptotic patients.
Puckering at the edge of the areola is possible.
(anchor, Diagram 4): The
most commonly used technique for those with severe ptosis is with an anchor-shaped incision that
starts at the base of the areola, then vertically to the where the breast
crease meets the rib cage and then along the lower portion of the
breast at the natural crease (or slightly higher).
Nipple re-positioning is sometimes necessary with this technique as
the nipple must be partially removed (see below) and left on a
pedicle of flesh to retain the blood flow. This is
considered one of the major scarring techniques (with the below
being the most scarring) but it sometimes necessary with severely
sagging breasts. With the Standard Mastopexy, the resulting
scar appears as the shape of an anchor at the natural crease of the breast
up to the areola (darker skinned area) and nipple area.
(anchor) with an areolae reduction or relocation (Diagram 5):
is sometimes needed or requested to decrease the size of the areolae
complexes. This includes the anchor lift scars with the scars
around the areola as with the peri-areolar lift.
Resulting Breast lift Scars Depicted In Blue
click graphic for the full
Areola Reduction: This
is pretty much a Benelli lift, however the only tissue excised is a
doughnut of tissue on the actual areola itself. Some women may be
displeased with the size of their areolae which may be enlarged due to
genetic predisposition, previously having had large breasts then
undergoing tissue loss, stretching of the areola due to implants or other
reasons. The areola reduction surgery is designed to remove the
redundant areola tissue to improve the overall cosmetic appearance of
enlarged areolae. The reduction may result in a slight lift and may
also produce slight irregularities at the incision line if the
reduction was significant. The areola skin is thinner than the
surrounding tissue, so slight distortion is possible if proper
support is not worn.
Diagram depicts the dramatization
of a patient undergoing a Benelli Lift with Areola Reduction and Breast
click graphic for the full
TYPICAL PATIENT AND PREOPERATIVE FEATURES
- Desire for a smaller
diameter and rounder and more proportioned size of your
- Reduction of the puffy or
large or bulging areolae that you would like flatter.
- Anesthesia is usually a very
light general and the procedure takes about two hours.
- The procedure involves an
incision around the areolar edge and a smaller incision
with removal of the excess tissue in between, like a
- The incision is very
inconspicuous and located around the final edge of the
- Dressings and a light gauze
bandage worn for several days.
- This can be combined with
other plastic surgical procedures.
- You can go home after
- You can shower on the next
- There is only minimal pain
that is mostly gone by the second or third day and easily
controlled by medications.
- Minimal or no swelling is
- Minimal or no bruising is
- You can resume most
activities in less than the first week.
- The stitches are removed at
- Expect to be off of work
only two days or less.
- Beautiful, balanced and
proportioned contour and size and shape to the nipples and
- Lasts the rest of your life
and always looks better than if you didn't do it.
- Natural and presentable
appearance in the first week that just gets better over
the next three to six months.
James Romano, San Francisco, California Board Certified
Complications & Contraindications of The Benelli (Peri-areolar) Breast
There are great benefits in getting
a mastopexy to those who need it, but everything comes with risks.
The most severe risks are
attributed to anesthesia. There may be an allergic reaction to the anesthesia
or medications, especially if you have failed to make known your current
medication consumption, or if you have not ceased consumption of alcoholic
beverages or illegal drugs as instructed.
Abide by your surgeon's instructions regarding the consumption of food and
liquids before your surgery as well. Risks of intubation are exacerbated
when the patient is an asthmatic. Please read the All About Anesthesia Section
for more information.
Other risks include
hematoma (internal bleeding) and/or seroma (fluid build up which may
require aspiration) are possible, leading to additional surgeries.
Infections, although rare can
happen when bacteria such as Staph, which naturally lives on your skin,
gets into your incision area and multiply or develop. Washing your breasts, neck and torso with an anti-bacterial
soap like Hibiclens or even Dial anti-bacterial soap for several
days up until your surgery can reduce the amount of Staph on your
skin. Infections can also develop intra-operatively from unsterile equipment used by a surgeon or staff of the surgeon. Infections can also
result from the introduction of bacteria post-operatively through improper
dressing changes, bathing or swimming in water which contains infectious
Although very rare, another risk is tissue
necrosis. Necrosis can happen when the tissue loses its blood
supply. Your chances of necrosis increase if you smoke and/or you have poor
oxygen-tissue saturation, the surgeon did not use a pedicle
to keep blood flowing to your nipple or other skin sections that were
reattached, or severe post-operative swelling disrupted the blood flow.
Necrosis can also be the result of an infection.
Numbness and lack of
sensation can be problematic, although usually temporary.
Unfortunately this can be a permanent problem in some cases.
It is a complication we must be aware of before undergoing mastopexy or
mastopexy with breast augmentation.
Keloidal & hypertrophic scarring is
possible in those who are prone to such. This is when the scar
tissue forms outside of the area of the wound. It can result in
thick, ropey scars.
where one breast or nipple may appear higher, or larger
than the other. Your areola may not be
completely round, edges may appear jagged or the areola may appear oval in
You may have incision
line puckering, which may resemble the opening of a drawstring bag.
I do have puckering but it lessened over time.
The breasts may also have less
projection if you have chosen to have a Benelli breast lift without the
insertion of breast implants. My breasts have
slightly less projection as compared to before my procedure. Then
again, I have had several peri-areolar lifts due to
repeat wound opening and I had implants. When you have adequate
breast tissue or breast implants, the puckering is very minimal.
Your chances of any of the above happening can be
significantly decreased when you have a
qualified plastic surgeon to perform your Breast Lift. Following
your surgeon's instructions can further decrease your chances of having a
complication. Please abide by your surgeon's instructions for a
smoother, more pleasant recovery and results.
There are many studies which report
that keloid scars were prevented (and lessened in existing cases) with the
use of silicone sheeting and gels. There are several scar therapies
on the market, including the below sheets which are made specifically for
mastopexy procedures made by
click graphic for the full
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