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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 ptosis.

What is the Benelli (Peri-areolar) Breast Lift? 
Mastopexy 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?
First 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.

Your Consultation Appointment
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.  

At this 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 ribcage.

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• 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.

• Pseudo-ptosis (Pseudoptosis):  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.

The Benelli Lift (concentric, or peri-areolar, donut or doughnut lift)
This technique 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 appear more 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.

Other Available Breast Lift Techniques

• The Crescent 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.
   

• Full Mastopexy (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. 
   

• Full Mastopexy (anchor) with an areolae reduction or relocation (Diagram 5): This 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

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• 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 Implants.

click graphic for the full size image

Risks, Complications & Contraindications of The Benelli (Peri-areolar) Breast Lift
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 agents.  

• 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. 

• Asymmetry, 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 shape.

• 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.

Scar Treatments
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 www.BioDermis.com

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