Areola or crease incision for explant?

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...

Doctor Answers 18

Implant Removal

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.

Scottsdale Plastic Surgeon
5.0 out of 5 stars 49 reviews

Circumareola to remove excess skin after explant

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. 

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

Explanation incision

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.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Implant removal

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

Mahlon Kerr, MD, FACS
Austin Plastic Surgeon
4.9 out of 5 stars 217 reviews

Incision for explant

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.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Capsular contracture after breasts augmentation

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 

Ramon Navarro, MD
Mexico Plastic Surgeon
5.0 out of 5 stars 2 reviews

I use an inframammary fold incision for better control

Please find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers!

In breast augmentation I have chosen to spend time reviewing photographs with patients to fully understand their expectation of size and shape. Many times this simply raises more questions. I will make measurements and use the implant guides to allow the patient to understand exactly the sizes that are reasonable for their body type and measurements.

Location of scar after breast implant removal ?

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.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 47 reviews

Crease gives necessary exposure

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!

M. Scott Haydon, MD
Austin Plastic Surgeon
4.8 out of 5 stars 90 reviews

Which incision for implant removal

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. 

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 84 reviews

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.