It is not unusual for the areola to enlarge with pregnancy and breastfeeding, as the breast gets larger form milk engorgement. It can also occur from breast enlargement caused by weight gain or to simply stretch with age. Some patients are genetically prone to have a larger areola and this is very common in those who have a condition known as a constricted breast; a condition that is also referred to as a tuberous deformity.
Breast Lifts and Reductions
During most breast reductions and standard breast lift surgeries, it is common to reduce the size of an areola that is larger than normal in size by removing excess skin around it's peripheral edge. A 'cookie-cutter' is used in surgery to mark the size and shape of the areola to make a circular shape as symmetric as possible around the nipple.
For those who do not need a breast reduction of much of a lift, it is still possible to reduce the size of the areola by performing a smaller lift that is concentrated around the areola; this is known as a peri-areolar mastopexy, donut mastopexy or Benelli lift. In this procedure, the proposed size of the areola is marked with the cookie-cutter and an outer circle is designed around the natural edge of the areola. The skin in between the two circles (shaped like a donut) is removed and the skin edges are approximated with sutures. In an effort to prevent the areola from stretching out and becoming too large again, a permanent suture is often placed in a circular fashion around the edge of the areola, buried under the skin.
This type of breast lift, concentrated around the areola, is commonly used along with breast implants to improve the shape of patients with constricted breasts. This procedure also helps these patients to have a smoother break contour, as they tend to naturally have an abnormal bulge of their areola due to herniation of their breast tissue into the areola.
Breast Implants can result in enlargement of the areola as the skin is stretched to accommodate the increase in breast volume. Some patients who were not concerned about the size of their areola prior to surgery may be displeased with the increase in the size of the areola after breast augmentation surgery. This typically occurs only in women who have some enlargement of the areola to begin with, some loose skin and who get relatively large implants. In these cases, it may be wise to consider a procedure to reduce the size of the areola at the time of the implant surgery.
Any procedure that is done to reduce the size of the areola will leave a scar around its edge. Unfortunately, there is no way to predict what the scar will look like. In many patients, it is a fine line; however, in some, the scar gets thick, pink and raised. This may take several years to go down and leave a wide, flat, pale scar.