Some surgeons perform a “doughnut excision” in an attempt to either decrease the diameter of an extremely wide areola, to raise the nipple position or to take up some anticipated loose skin or any combination of these problems. When this technique is performed, very careful suturing is required, frequently with a permanent circular suture under the skin to keep the diameter small. However, this suture can be felt just under the skin and may be objectionable to the patient. If a permanent suture is not used, then spreading of the areola or the scar or both may occur due to the competing tensions of the surrounding skin. In these circumstances, substantial improvement may not be possible unless the patient would accept a permanent but feel able suture under the skin.
Alternatively, some surgeons, when faced with a large pendulous breast, may opt to use an “inverted T technique” which is frequently used for female breast reductions. In these situations, virtually nothing can be done to eliminate the resultant scars except, if needed, a scar revision to improve the scars themselves.