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!
Periaerolar Incision Risks?
Doctor Answers 29
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, then it is because most likely he is not familiar with the technique and will say that it causes more infections, contracture or loss of sensation or inability to breast feed which in my experience is just not the case!
Also, I do not recommend the axillary incision for again if it is a bad scar(10-15% of patients), the patient will have to be aware when she raises her arms. Also, unless endoscopy is utilized, it is a blind procedure(the surgeon cannot visualize the pocket he is creating or has created)which will result in a number of patients experiencing asymmetry in placement of the implants. It is quicker and that is why it is used primarily.
The belly button incision is fine but you cannot place silicone implants through it and the chances of asymmetry and misplacement of implants is higher because again it is blind, unless endoscopy is used.
Also, with all these incisions, loss of sensation of the nipple can and does occur but in about the same percentage or about 1%.
An informed patient about these incisions is the best patient! Watch my videos and see the all inclusive special pricing that I am featuring for breat enlargement.
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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.
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 augmentation mammoplasty is very rare and the incision site would not have any bearing. In my own practice, I have yet to experience a single significant infection in 26 years of performing augmentations.
As for periareolar incisions, they definitely heal quite well from a cosmetic standpoint but since a portion of the breast ducts will be divided, there may be potential issues with breast feeding (which could certainly be addressed at that time). In terms of scarring, I would like to echo Dr. Dadvand's remark that "if done properly both incisions are inconspicuous".
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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 that usually disappears into a fold in the armpit.
All the best,
Rian A. Maercks M.D.
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. This can be lessened by protecting the implant from the nipple on insertion and a careful dissection plane down to the implant pocket. This incision, in my hands is utilized if the patient needs a breast lift or mastopexy, if I need to lower the breast fold, or if the patient requests it. I do not use it routinely, and have difficulties in the patient with small areola. I have found there may be more incisional discomfort with this, though it is the second line incision for breast augmentation and if performed correctly, I have seen no increased risk of capsualr contracture.
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 dissection/creation, and faster operating time. The tradeoff is the more apparent scar. However, the periareolar incision is quite popular and also has the benefit of being within the surgical field when performing a concomitant breast lift. Revisions tend to be related more to the implant size or complications unrelated to the approach (hematoma, capsular contracture, rippling).
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.
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 of the breast implants to the patient's skin(even though it has been washed off with a sterilizing prep solution) or anything that has had contact with the skin. This is the "no touch" technique. I have found the Keller Funnel to be essential for "no touch", especially with an incision around the areola and especially with gel implants. Someday, we might know the answer to your question, but we don't now.
Lisa Lynn Sowder, M.D.
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 the submuscular position (over the muscle).
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.