Infection really is not the main issue with this approach. Capsular contracture (scarring around the implant leading to a firm, distorted, painful--in some cases--breast) is the issue. Studies have now shown that the periareolar approach results in higher rates of capsular contracture. My goal is #1 safety and #2 beauty. I encourage women toward the IMF approach. I place the incision directly into the fold and it becomes very well hidden once healed.
I have performed well over 5000 breast augmentation surgeries, the majority of which were through the periareolar route and infections are exceedingly rare. The right surgeon and good sterile technique will eliminate any increased risk from any of these approaches. I've also performed quite a few axillary incision breast augmentations (although not my preferred method) and have never had a single infection, so often times surgeons may guide patients to a particular approach they feel most comfortable with for a variety of reasons. The point is, there are several approaches available for a breast augmentation and there are pros and cons to each approach but I do not feel that infection risk is a significant factor in the decision. Good luck.
The most commonly used incision in breast augmentation today is the inframammary approach. Compared to the axillary and areolar incisions the inframammary incision carries the fewest side affects such as infection, nipple sensory changes and capsular contracture. This information is not just one surgeons word against another, it is based on scientific studies. I provide all of this information too my breast augmentation patients, but in the end it is her (the patients) decision as to where to locate the incision.
I quite often use the periareola incision, and it was my preferred technique when I used saline implants. I never saw an increased risk of infection with this approach.
Hi and thanks for the question. I agree with my colleagues. The studies show the axillary to have the highest rate followed periareolar. That's for the obvious reasons of having sweat glands and lactiferous ducts. I use barriers and triple antibiotic irrigation to try to reduce the potential for contamination. My ideal approach is the infra mammary and the incisions seem to heal quite well. I hope that helps. Good luck!
The inframammary incision is straightforward and for this reason many surgeons like to use it. However, it does leave a scar that is more visible than the other options. Each incision has its advantages and you should be able to choose the one you would like after hearing the pros and cons of each.
There is clearly a difference in potential infection rates for the three most frequently used breast augmentation incisions. The infra mammary incision has the lowest rate, the peri areole has a rate 6 times that of the infra mammary, and the transaxillary has the highest at 12 times that of infra mammary. The consequence of these infections refer to the possibility of having increased capsular contracture around the implants, thus making them feel firmer. Having said that in my practice I use both the infra mammary and periareolar incisions very frequently without noticing a big difference in contracture rate
Good luck to you.
Frank Rieger M.D. Board Certified Tampa Plastic Surgeon
Since infection is so rare after augmentation, it's rare to have a study that includes enough patients and is organized well enough to show the true difference between the incisions. However, low grade infection is one of the things that can contribute to capsular contracture, and there is a very well designed study of hundreds of patients that shows that transaxillary incisions produced the highest incidence of contracture
(6.4%), followed by periareolar (2.4%) and inframammary (0.5%).
That said, if you prefer the periareolar incision, then I would ask your surgeon to perform the procedure that way. Using a protective layer between the implant and the skin (like a Keller funnel or a Tegederm) while the implant is being inserted can reduce your risk even further.
One of the ways to reduce bacterial contamination of the implant is to place sticky barriers (Tegaderm) on the nipples during breast augmentation.
While it is possible to do going through the areolar incision, it is more difficult to maintain the barrier with all the manipulation of surgery.
The surgeon has to cut through some ducts near the areola which may contain bacteria. Bacteria may lead to capsular contracture or other issues.
Going through the nipple makes it more difficult to deal with the infra mammary fold, to do a dual plane muscle release and to place sutures which reduce the possibility of bottoming out.
I much prefer the fold incision as well and no longer do the armpit incision, and prefer not to do the nipple incision if at all possible.
The areolar can heal nicely, but if it doesn't, it's right there and obvious and not possible to remove. There are other issues such as contour problems which can occur with this approach.
Infection rate is likely similar (low in my practice, less than 1%), but the capsular contacture rate is a little higher in my experience with a peri areolar incision