Areola or crease incision for explant?

Question

I've had my 450 cc silicone implants for 3 yrs and have decided to remove them. I went in for a consultation and the PS suggested a crease incision to avoid "puckering" of the nipples.. My original incision was through the areola. I have grade 3 capsular contracture on my right breast so it rides high and does not have a crease, my left is perfect and soft with a little crease.. I was a 32B prior. My concern is I don't think I will have enough breast tissue to make a crease to cover the crease incision...

Gary M. Horndeski, MD · Answer

450
cc implants are quite large.  When these
implants are removed, you will have excess hanging skin.  For that reason, I recommend a new technique
called Explant with Mini Ultimate Breast LiftTM.  Using only a circumareola incision it is
possible to reshape your breast tissue creating upper pole fullness, elevate
them higher on the chest wall and more medial to increase your cleavage.  Through the same incision, the implants can
be removed and excess skin can be resected. 
Aligning the areola and breast tissue over the bony prominence of the
chest wall maximizes anterior projection. 
This technique avoids the ugly vertical scars of the traditional
technique, maintains nipple sensation and the ability to breast feed.  An inframammary crease incision allows only
implant removal and you will end up needing a second operation later to remove
the excess hanging skin. Best Wishes,Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

It is true that the inframammary crease incision has the downside of extra scars.  Your surgeon does make a good point about using the areolar incision.  I have done explanations through the original areolar incision, only for there to be a resultant puckering and indentation at the site of the scar.  The ultimate choice is yours.

Mahlon Kerr, MD, FACS · Answer

The same incision could be used and if you get some puckering that could be addressed. The alternative is to use the fold incision.  I think it just depends on your preference and how likely your PS thinks reusing the areolar incision will cause you a problem

Steve Laverson, MD, FACS · Answer

My custom, unless contra-indicated, is to use the scar you already have.  This has always worked out for explantation alone, even when capsulectomy necessary. If transaxillary scar, situation different, but that doesn't apply to you.

M. Scott Haydon, MD · Answer

Thanks for your question. I would only do this through an IMF crease incision. This provides me the exposure I need to remove scar tissue and manipulate the pocket. The scar heals exceptionally well. Best of Luck!

William T. Stoeckel, MD · Answer

There are good reasons for each of the incision choices. I would probably agree with your surgeon and use the IMF incision. In the end, the choice should be yours. Discuss the risks and benefits of both choices with your surgeon and then choose the one that seems best to you. There really isn't a right or wrong answer.

Kenneth Hughes, MD · Answer

This really cannot be answered without an exam.  I do see quite a few patients who have had removal from the infraareolar incision elsewhere with some puckering that requires another revision.Kenneth Hughes, MDLos Angeles, CA

Richard J. Brown, MD · Answer

That is a good one. As I was reading your question I was wandering if you had a contracture or not. So I tend to agree with a breast crease incision if  a capsulectomy is to be done. Much easier for for the patient and the surgeon. Nipple incisions are very difficult to perform a capsulectomy through.

Jourdan Gottlieb, MD · Answer

Puckering is a consideration, as is adding a new incision, and the pros and cons must be weighed carefully by you and by your surgeon in reaching a decision. Chances are if you were symmetric before surgery, you will wind up with the same sort of fold on the right. Although I might feel differently were I able to do an exam or at least see a photo, I do favor, slightly, the fold incision.  Most patients will notice an irregularity in the areolar incision moreso that the same irregularity in the fold.All the best.

Ramon Navarro, MD · Answer

almost 20% of whole patients develop a capsular contracture than might be corrected properly  without  any new surgery, this is done by any qualified plastic surgeon by external ultrasound  besides monteleukast tabs, thanks for your question

Areola or crease incision for explant?

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