Plastic surgeons performing cosmetic procedures always wish to get the best aesthetic result while creating minimal and well hidden scars. The periareolar breast lift (mastopexy) allows the nipple position to be elevated while reducing the areolar diameter (when needed). This technique only uses an incision placed around the outside edge of the areola of the nipple. However, this approach does have its limitations with respect to how much the nipple can be raised and how much the breast tissue can be reshaped. Other techniques utilizing vertical incisions below the nipple (lollipop) and sometimes even along the fold at the bottom of the breast offer much more versatility in what can be accomplished.
As a general statement, if the nipples are more than a little below the bottom folds of the breast, then a donut (periareolar) mastopexy will usually not be able to give the breast the lift that it needs. The periareolar mastopexy is best suited to raising the nipples relatively small distances of two inches or less. Elevation much above that distance causes a significant amount of pleating in the skin of the breast around the nipples which may not resolve with time. Further, through the donut mastopexy incision, access to the breast tissue is limited and significant changes in breast shape cannot be accomplished.
Breast implants may be placed through the periareolar mastopexy. Adding breast implants will of course have an impact on the breast shape but more importantly will increase breast size. If a breast lift is performed, there may be a limitation on how large the breast implants may be when placed at the same time without placing too much stress on the breast lift incision(s).
A consultation with a board certified plastic surgeon is the best way to determine if a woman is a good candidate for a periareolar breast lift. Seek the consultation of a plastic surgeon certified by the American Board of Plastic Surgery. Members of the American Society of Aesthetic Plastic Surgery (ASPS) will all be board certified in plastic surgery and have demonstrated an interest and competence in cosmetic plastic surgery as well. I am a board-certified plastic surgeon and member of the ASPS.