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Periaerolar Incision Risks?

asked 1 year ago by 7080anon in Washington
Latest answer by Rian Maercks, MD
Question viewed 905 times
Tags: female, capsular contracture

Hi all :) Would you please let me know in your opinion, what is the risk of capsular contracture and bacterial infection for the periaerolar incision, compared to the inframammary fold one? How much higher is it theoretically and practically? Do you experience more revisions with this incision than the inframammary fold one? Your feedback is greatly appreciated, thank you!

28 answers to Periaerolar Incision Risks?

+2

Peri Areolar Incision and Capsular Contracture

Thanks for the question.  Data would suggest that the chances of developing a capsular contracture are slightly higher when utilizing a peri areolar incision. In my practice, the peri areolar incision is my preferred approach as it is with my associate. We experience a cc rate that is comparable, if not lower, than the national average. I believe the peri areolar approach provides the added benefit of  allowing for NAC asymmetry correction, should it exist. It provides a... more
Glenn Vallecillos, MD

Beverly Hills Plastic Surgeon

www.BeverlyHillsCosmeticSurgeon.com

+2

Cc after nipple incision

The risk of cc is increased with periareolar incisions due to cutting across breast ducts with that approach. Theoretically bacteria in the ducts contribute to cc. Use of   inframammary incisions avoids this  as you do not violate breast ducts. Much of this is based on thoery, but I personally cannot  say I see more revisions with either approach.
Daniel J. Casper, MD

Los Angeles Plastic Surgeon

www.drdanielcasper.com

+2

Periareolar Incision for Breast Augmentation: Risks

The periareolar incision (under the nipple) for breast augmentation and placement of breast implants is not as common as an incision choice as the lower breast fold or infra-mammary fold incision. The incision is curved under the border of the nipple pigment and actually heals very well. There may be a theoretic increased risk of capsular contracture secondary to bacterial contamination of the breast implant because of the close proximity to the nipple ducts, both internal and external.... more
Andrew P. Trussler, MD

Dallas Plastic Surgeon
+2

Incision choice and risk.

In theory the periareolar incision has a slightly higher risk of contamination from bacteria within the milk ducts of the breast in comparison with the inframammary incision. However, with appropriate surgical technique, adequate irrigation of both the pocket and the incision, and the use of antibiotics this theoretical risk does not appear to be a large influence from a practical standpoint. The inframammary fold incision allows for easier placement of the implant, simpler pocket... more
David Bogue, MD

Boca Raton Plastic Surgeon
+2

Risk of Infection based on Incision Point?

I don't think that there is any difference.  Infection is rare by any incision and is not more common based on the incision point. 
Robert N. Young, MD

San Antonio Plastic Surgeon

www.dryoungforever.com

+2

Periareolar incision

There is no study or series that I know of that definitively answers your question, which is a very good one.  There has been at least one well designed animal study that shows low level bacterial  infection on implants increases the chance of capsular contracture.  We also know that bacteria often live in breast ducts.  It's easy to put these two things together but it ain't necessarily so.  I think it's super important to absolutely minimize contact... more
Lisa L. Sowder, MD

Seattle Plastic Surgeon
+2

Risk of capsular contracture more related to implant location than incision site

Bacterial infection of a breast implant can occur with any incision site whenever there is a break in sterile technique. Although there is thought to be a correlation between bacterial colonization of a breast implant (not overt infection) and development of capsular contracture, there are no studies demonstrating this effect. However, there are studies that show higher rates of capsular contracture for implants placed in the subglandular position (above the muscle) than for implants in... more
Kevin Brenner, MD

Los Angeles Plastic Surgeon
+2

Breast implant incisions

I use the peri-areolar incision almost exclusively. In my experience the incidence of capsular contracture or infection is very low and no different than any other incision. The inframammary incision is good but it will reult in a bad scar in about 10-15% of patients and then it will be noticeable if the bra or the swimming suit rides up. I literally most times cannot find the peri-areolar scar after several years on my patients. If your plastic surgeon is not using that incision,... more
Edward J. Domanskis, MD

Orange County Plastic Surgeon
+2

Periareolar vs inframammary incision for breast augmentation

I do let the patient decide what incision to use, but I prefer the periareolar.  There is no increased risk of infection nor loss of sensation.  If the patient need a lift in the future, then the incision can be extended all of the way around to accomplish this.  I have seen some inframammary scars that have ugly widening and prolonged erythema.
Kenneth L. Stein, MD

Chicago Plastic Surgeon
+2

Periareolar vs inframammary fold incision for breast augmentation

From a practical standpoint there is no increased risk of capsular contracture when performing a periareolar incision when compared to an inframammary fold incision. Fortunately, with the use of cohesive gel silicone implants, or ones that are saline, the incidence of capsular contracture has dropped to such a low percentage that surgeons who have been operating for a decade (or two!) are now much less concerned about this complication than we were years ago. Infections with... more
William F. DeLuca Jr, MD

Albany Plastic Surgeon

www.delucaplasticsurgery.com

+2

Periareolar Incision Risks

I typically allow my patients to choose their incision of choice.   Although it seems theoretically possible to have a higher incidence of infection and sensation change with the peri-areolar incision, it has never been shown to be true in the literature.   Therefore,  I let the patient choose, although I point out that the peri-areolar incision may be easier to hide in patients with small breasts and wide areola or  a lack of an inframammary fold.
Paul S. Gill, MD

Houston Plastic Surgeon

www.drpaulgill.com

+2

Breast Augmentation Incisions- Key Considerations

There are 3 primary  incision options for breast  augmentation. All are acceptable and depend on the patient's choice and the surgeon's experience and expertise- 1. The most common approach is in the Inframammary Fold - simple, easy access , heals well , and gives the best opportunity for correction of any subtle  breast asymmetries. It is the most common incision I use for both saline and silicone implants.  In my experience, it has a very small nipple... more
Rod J. Rohrich, MD

Dallas Plastic Surgeon
+2

Incision Options for Breast Augmentation

Your second question is very astute. Although there is a theoretically increased risk of capsular contracture and bacterial infection with a periareolar incision, this does not bare out clinically. Ultimately the ideal study would be to perform one incision on one breast and another incision on the other and compare the results. However, most patients would not sign up for this type of study for obvious reasons. Also rthere are many factores that contribute to capsular contracture and it... more
Babak Dadvand, MD

Los Angeles Plastic Surgeon
+2

Which is The BEST Incision in Breast Augmentation Surgery?

It would be a wonderful thing if a properly picked breast implant could be magically beamed / transported into a breast without putting any scar on it or in adjacent tissue. Unfortunately, until that day comes, we need to choose between the positives and negatives associated with each breast incision / scar. Furthermore, every woman contemplating a Breast Augmentation must accept that these implants will not last a life time; They WILL leak anywhere from the day of surgery up to 25 years... more
Peter A. Aldea, MD

Memphis Plastic Surgeon
+2

Perioareolar (nipple) incision with breast implant augmentation

I use the periareolar incision in approximately 50% of cases as it allows some versatility in adjusting the height of uneven areolas. However, the limitations are thes size of the areola (small ones do not allow placement of larger silicone implants) as well as the concerns for bacterial contamination with biofilm and subsequent capsular contracture (CC). Having said that, it is my overall impression that the rate of CC is roughly equivalent in my... more
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+2

Periareolar vs Inframmary or Transaxillary Incision

Thanks for asking a good question.  I have never experienced a breast augmentation infection whether using periareolar or transaxillary incisions (my two preferred approaches).  The only negative of a periareolar incision is the likelihood that breast feeding will be more difficult to start and/or maintain due to some of the breast ducts being severed.  The approach however leaves a consistently small and barely visible incision and the risk of loss of nipple sensation is no... more
Jon A. Perlman, MD

Beverly Hills Plastic Surgeon
+2

No increase of complications with areolar incision

I have been using both inframammary and peri-areolar incisions for breast enlargement for over 10 years, and have seen no significant difference in incidence of capsular contracture or infections between both approaches. The areolar approach delivers a superior scar to my opinion, and also allows the surgeon better 360 degrees access to the pocket. It is my preferred approach.
Alexis Verpaele, MD

Belgium Plastic Surgeon
+2

Breast implants through a periareolar incision has benefits

Comparing breast implant incisions can be difficult and each has its champions, though we tend to like the periareolar incision very much. We have used the periareolar approach for over 25 years and find that with care the incision is much more difficult to see, and more easily concealed than the inframammary, or under the breast approach. The periareolar incision does not affect nipple sensation any more than other approaches, does not impact breast feeding, and does not lead to any... more
Peter E. Johnson, MD

Chicago Plastic Surgeon

www.peterejohnsonmd.com

+2

Periareolar Risks

In my mind, the literature does suggest a slightly higher incidence of capsular contracture when implants are placed through the PA approach.  In addition, there is potentially a higher risk for change in nipple sensation.  And, the scar is on the most projecting portion of the breast and so it potentially has a higher risk for being more noticeable. That being said, many surgeons achieve great results through all three approaches and so it really comes down to a decision of... more
Gregory A. Buford, MD

Denver Plastic Surgeon

www.beautybybuford.com

+2

Periaerolar Incision Risks

Interesting question. In theory, the peri areolar incision for attaining exposure in breast augmentation has the following increases in risks: 1. capsular contracture, 2. decreased or loss nipple/areolar sensitivity, 3. decrease or inability to breast feed. In vivo experience the capsular contracture rates are essentially the same. I have seen 30% decreased in sensation and a 10-% to 20% breast feeding problems. Hope this answers the question. From MIAMI Dr. Darryl J. Blinski  more
Darryl J. Blinski, MD

Miami Plastic Surgeon
+2

Periareolar incision often a good choice

It sounds like you are aware of the theoretical risk of the periareolar incision, which is in closer proximity to breast tissue leading to possible bacterial contamination and capsular contracture. There isn't much evidence to support that in my view. Another misconception is that it increases the chance of sensory loss to the nipple, also unproven. The inframammary incision works well but if the implant size is ever changed it may no longer be in the fold at the right level. There are... more
Richard Baxter, MD

Seattle Plastic Surgeon
+2

Breast augmentation incision location

No one really knows what causes capsular contracture but there is likely a combination of causes with some being more dominant is some patients. Factors believed to cause capsular contracture include low grade infections, repeat breast surgeries, genetic factors, blood in the implant pocket, rough handling during surgery causing muscle spasm etc., implant rupture, trauma to the chest, radiation etc. Those are mostly independent of the skin incision used. Revision rates are something else... more
Aaron Stone, MD

Los Angeles Plastic Surgeon
+2

Periareolar incision is safe

Periareolar incision incision has the same safety profile in my experience.  Incision size is limited by the areolar size which can be an issue, especially with silicone implants.  Which position will produce less noticable scarring depends how visible the inframammary fold region is and what kind of scarring results
Daryl K. Hoffman, MD

Los Gatos Plastic Surgeon
+2

In my practice the peri areolar incision almost always results in a minimal scar and very low capsular contraction rate.

I don't believe there is a difference in capsular contraction rates between peri areolar and inframamary incision in breast augmentation and the scar is far better in the peri areolar incision.  There are many other techniques which will change the capsular contraction rate. These include preoperative antibiotics, careful tissue handling  techniques, changing gloves before putting the implant in the pocket, irrigation of the pocket to remove loose tissue and blood, instillation... more
Carl W. "Rick" Lentz III, MD

Daytona Beach Plastic Surgeon
+2

Periareolar Incision Risks No Greater than Inframammary

I do not feel that there is an increased risk in either capsular contracture nor infection with a periareolar approach to augmentation.  I use both incisions and have never had an infected implant although that is always a risk with either incision.  My scar reviision rate is greater with inframammary scars than with periareolar scars.
John Whitt, MD

Louisville Plastic Surgeon
+1

Incision choice in breast augmentation

Infection in breast augmentation is very rare when performed to todays standard of care. Of the two approached, I prefer periareolar as the inframammary if low can show under a bikini and if high is plainly visible in the nude when standing. It is my preference to never place a scar on the breast when elevating the nipple is noot necessary which is why I prefer to perform transaxillary cold-subfascial augmentation. The patient is lifet with a very thin scar in the armpit... more
Rian Maercks, MD

Miami Plastic Surgeon
+1

Risks of periareolar approach for breast augmentation

Any increased risks for infection, whether theoretical or real are very minimal.There are many other factors to consider beyond just the scar placement to review with your surgeon when making this decision. This discussion is too long for this box, but a thorough discussion should be had with your surgeon regarding your particular case.
Neal Goldberg, MD

Westchester Plastic Surgeon
+1

Incisions and infection or capsule

I do no think it make a difference what incision is used for surgery in terms of increasing the risk of an infection or capsular contracture.
Steven Wallach, MD

Manhattan Plastic Surgeon

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