I am scheduled for a BA on October 24th, 2012. I am having 300cc cohesive gel implants inserted through a periareolar incision and they will be placed under the muscle. My question is this, since the PS has to cut through the breast tissue will this leave my natural tissue lumpy or cause dimpling or any kind unsightly or physical ramifications? Or does the breast tissue repair itself back to its pre-surgery state?
Breast Tissue and the Periareolar Incision?
Doctor Answers (12)
Periareola incision and implants
Using a periareola incision is a very popular approach for implants placement. It is unlikely to have any issues that you described.
Periareolar incision and breast augmentation
Periareeolar incision can be used for both sub-pectoral and sub-glandular placement of implants. The advantage is that the incision is less visible due to the color difference between skin and aureola. However in order to place the implants, breast tissue has to be dissected and some scarring will occur within the breast tissue. A precise layer closure will prevent visibility of these scars, but the may be palpable if not closed properly, and some scarring may be seen on mammograms in the future. If there is a breast fold, infra-mammary incision avoids the issue scarring in the breast since dissection avoids any breast tissue, but the scar may be more visible but the breast fold if present will hide this short scar.
Will a periareolar incision and under the muscle approach for breast augmentation result in lumpiness?
The periareolar incision and placing the implants under the muscle is a very common approacj which usually leads to very satisfactory results. It is very rare to get any kind of postoperative lumpiness as a result of cutting through the breast tissue to have access to the behind-the-muscle pocket. Good luck!
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As long as you heal properly, the location of the incision should not affect your breast tissue or nipple sensation or the ability to breast feed.
Periareolar breast incison should not end lumpy
The periareolar incision gives access to the lower edge of the breast, and generally a subglandular pocket is developed up the the chest muscle and then continued under the muscle above. If the breast is closed by 'layers' the incision or breast should not be lumpy or affect the nipple either.
Breast Tissue and the Periareolar Incision
If any of the commonly used incisions were demonstrably superior to the alternatives, we would all use the same incision. And we don't. My general preference is for an incision under the fold, which does minimized the tampering with breast tissue.
But surgeons get excellent results with any of the insertion sites. Best discussion of the issues involved would be with your surgeon, who can review the pros and cons base upon your individual anatomy and goals.
Nothing is guaranteed, but most of our patients when they do the incision through their nipple it come out really nicely. The skin around the areola is very thin and the scar is very forgiving. You have scar therapy you can use to help the scar be is minimal as possible.
Breast augmentation and periareolar incisions.
With the knowledge and experience of many years, I would strongly advise against a periareolar incision today. It's not because of lumpiness or dimpling and it's perfectly possible to put an implant in using this approach. The reason is that although it is not considered proven, I and other plastic surgeons feel that this approach leads to much of the capsule contracture seen with breast augmentation. The other reason is that if you ever need a revision, replacement, or choose to remove or replace your implants later on, it is not advised to go back through the periareolar approach. The inframammary crease incision has proved to be the best approach for both short term issues including violating the breast tissue and for the ease in returning to the implant later if ever needed.
Complications with periareolar incision
Thank you for your question. Provided that the areolar diameter is wide enough, a periareolar incision is a very common approach for implant placement. One of the benefits of this location is the camouflage that the areola provides. The problems you describe should be uncommon if your surgeon precisely closes the tissue in its proper layers. Two criticisms of this scar placement are that 1) the scar is in a more visible location and 2) because the periareolar approach involves cutting through breast tissue, there may be a higher rate of capsule contracture (implant hardness). You should have a discussion with your board certified plastic surgeon about the pros and cons of each incision location. Good luck!
Periareolar Breast Augmentation
Periareolar incisions usually heal very nicely, leave an attractive scar and are unlikely to cause distortions of the underlying breast tissue. As someone who used to utilize the periareolar incision frequently and now has switched to the fold incision, I do think there are some possible downsides that should be mentioned. Most importantly, there is evidence to suggest that the incidence of capsular contracture may be higher with the periareolar incision. While we do not know the precise cause of capsular contractures, we believe that bacterial contamination around the implant, possibly from bacteria that reside within the milk ducts, may play an important role. Also, numbness of the nipple may be somewhat more likely with the periareolar incision. You should speak with your plasic surgeon about your concerns so that you are well-informed before proceeding with surgery.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.