Will Areola Incision Damage Milk Ducts?

Question

My doctor seems to have a preference for the Areola incision due to its scar visibility, and he would use the Keller Tube to make it a smaller incision. However, I am younger and still want to breast feed my future children. Will an Areola incision pose a higher risk to damaging milk ducts or nerves than an infra mammary incision?

Amy T. Bandy, DO, FACS · Answer

When an incision is made around the areola, the breast tissue is then cut through until the area where the pocket will be made is encountered. So, yes, the breast tissue is cut, and the breast ducts are within the breast tissue. Not all ducts are cut, but some in-evitably are. When an incision is made under the breast or in the axilla, the breast tissue is not cut. I would discuss your concerns with your doctor, and decide on which approach will be best for you in light of the fact that breast feeding is important for you. Good luck!

Johnny Franco, MD, FACS · Answer

This is a good question as the majority of patient that wish
to have a breast augmentation desire a result that is going to feel and look
natural without having obvious scars.

There are several ways to place the incision so that it is
well hidden in natural skin folds or breast transitions.

1.Periareolara.Hidden at the natural transition from the areola
and the breast skin.  The incision can be
hidden in this natural color transition

2.Inframmary Fold a.The incision is hidden in the fold below the
breast.

3.Axillaa.The incision for the implant can be hidden in
one of the natural axilla folds.  I do these with the aid of
scope which allows precise placement of the implant.b.Also the use of the Keller funnel has allowed the placement of
larger silicone implants through the axilla.

No one incision is best for every patient and
the majority of patients can have the implant placed through any of the three
incisions listed above.  When do
correctly all three of the incisions are well hidden.

The incision at the border of the areola
typically does not affect the ducts as the nipple stay completely
attached.  I do agree with your surgeon
that the Keller Funnel allows for the implant to be placed through a smaller
incision and less traumatically.

It is important to see your board certified
plastic surgeon to help guide you to an implant that will give you an
aesthetically pleasing breast.

Ryan Neinstein, MD, FRCSC · Answer

Good question, one of the downsides of areola incisions is incresed risk of nipple sensitivty issues adn incresed risk of interfereing with breast feeding

J. Timothy Katzen, MD, FACS · Answer

I believe you should go with the periareolar incision as your surgeon suggests. I believe you should go with the technique that your surgeon is most comfortable with performing. Both surgical approaches and both surgeries have a risk of milk duct transection and therefore, decreased ability to breast-feed. In addition, there is not just one breast duct in the female breast. In the average female breast, there are anywhere between 13 and 25 or more breast ducts. The milk ducts are most concentrated around the nipple areolar complex. Typically, an incision around the nipple areolar complex does transect some, but not all of the ducts. I believe performing a nipple areolar complex incision and placing implants underneath the muscle would still allow you to breast-feed your future children. Sensitivity should remain intact even with the nipple areolar complex incision.

William T. Stoeckel, MD · Answer

The areolar incision often results in a beautiful scar. But the scars with other approaches can also be equally good. I believe that the scars from each of the 3 traditional approaches can all be great if done well. My personal opinion is that the inframammary incision offers the lowest risk of contamination and (for me) the best exposure and control of the implant pocket. I believe that the capsular contracture rate is slightly higher when using the areolar approach. With that said, I think that the areolar incision can be used with little risk of affecting your ability to breast feed. The risk of nerve injury is also quite low with either of the approaches. In the end, you need to be comfortable with your surgeon and your surgeon needs to be comfortable with the specifics of the procedure that he is using.

Thomas Fiala, MD, FACS, FRCSC · Answer

Recent studies have found that the areolar incision, while having a nice scar, actually does have a higher risk of complications compared to the inframammary incision - such as capsular contracture, nerve injury and chronic breast pain. Discuss this with your surgeon and make the choice that is right for you once you understand the risks and trade-offs.

Michael Horn, MD · Answer

You should still be able to breast feed after a periareolar incision breast augmentation if performed correctly. Your breasts may change shape after a pregnancy from getting larger and then shrinking.

Kenneth Hughes, MD · Answer

The infraareolar incision will not damage milk ducts if performed correctly. Sensation may change and be somewhat less than present, but most of these issues are transient. Kenneth Hughes, MD Los Angeles, CA

Hilton Becker, MD · Answer

The milk ducts enter the nipple from the interior of the breasts,therefore the circumareolar does not affect the milk ducts if correctly performed

	I use a nipple shield to prevent bacterial contamination frome the nipple

Pedro M. Soler, Jr., MD · Answer

Typically a periareolar incision will not preclude the ability to breast feed. Having said that, I favor an inframammary approach as there is a question of increased capsular contractures with the periareolar incision secondary to bacterial contamination from the ducts.

	I hope this helps. Best of luck.

Will Areola Incision Damage Milk Ducts?

Answers (16)

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