I am not in favor of this incision. It has a documented higher risk of capsular contracture, it is the most likely to affect breast feeding and it compromises the blood supply to the nipple areolar area which increases the risk of future healing problems in the event of mastopexy. If an incision heals perfectly, all fade out with time to the point of being very hard to see. If they heal poorly with widening, thickening, hyper-pigmentation or a very pale scar, the peri-areolar incision is a heartbreaker, staring back at you every time you face the mirror. I fully respect my board certified colleagues who choose this incision as it is main stream and well within the standard of care but I feel that a meticulously repaired inframammary incision is no more likely to be seen if it's perfect and far less likely to be seen if it heals poorly. There are many other advantages of the inframammary incision in my opinion but beyond the scope of a short answer format.
Areolar incisions do heal nicely
but they have more risks such as capsular contracture and less ability to breast feed. And when they are used repeatedly, they tend to retract, leaving depressed scars and contour irregularities. If you are marginal and will need a lift in the future, this approach would be fine to use.
Breast augmentation incision
Thank you for your question. Of the three common breast augmentation incisions - axillary, periareolar, and inframammary, I prefer the inframammary approach. The incision under the breast allows the implant to be placed without coming into contact the the breast tissue which decreases the risk of bacterial contamination and capsular contracture. However, there are situations in which a periareolar approach would be more appropriate. An example would be in a patient with tuberous breasts that require a circumareolar mastopexy. Hope this helps.
For years I would perform mostly the periareolar incision and then the last several years I changed and more often use the Inframammary incision. While I still use both I find that women have less of a chance of encapsulation with inframammary incision so keep that in mind. Main thing is go to a Board Certified Plastic Surgeon who performs a lot of breast surgery. Best of luck to you
Are you happy with your areolar incision?
The benefit of a trans-areolar incision is that the scar is less noticeable. However the data shows that the risk of capsular contracture is higher when a trans-areolar incision is used. If you want the best chance to avoid capsular contracture an inframammary crease incision is the best choice.
This is a question which will generate debate and much discussion among plastic surgeons which may lead to confusion. Depending on the patient's goals and anatomy, a surgeon can choose a periareolar or inframammary incision. Choose a surgeon that seems to best understand your needs, and allow him or her guide you accordingly.
Periareolar incision for breast enhancement with implants.
I must disagree with my friend Dr. M in that my experience performing breast augmentation over three decades has led me to strongly favor either a periareolar or axillary incision with avoidance of the inframammary scar. I have NEVER seen a prominent periareolar scar used for implant insertion (not a Benelli incision for uplift) and have seen dozens of women who regretted having a permanent dark, stretched, depressed or light scar under their breast that is easily visible from an inframammary scar. If your healing is less than optimal you're stuck with a visible scar that cannot be removed.I routinely use an insertion sleeve or "funnel" to avoid contact with nipple ducts during insertion and see a very low incidence of capsular contracture. Keep in mind that the transaxillary approach is also worth considering if your doctor is experienced and comfortable with the technique. Regards and best wishes.
Jon A Perlman MD FACS
Certified, American Board of Plastic Surgery
Extreme Makeover Surgeon ABC TV
Best of Los Angeles Award 2015, 2016
Beverly Hills, Ca
Set on a periarolar incision
Great question. I am in agreement with the inframammary crease favoring surgeons. This approach is inconspicuous as it hides in the natural crease of the breast, heals well and avoids damage to milk ducts and avoids cutting through the breast itself. This is important as it decreases the risk of the dreaded capsular contracture or thickening of the scar tissue surrounding the implant which can be an early or late complication of breast augmentation surgery. Cutting through the breast tissue via the areolar incision, in theory, drags bacteria from the breast (which is open to the air via the milk ducts and nipple) and though it typically does not cause an outright infection, it can lead to a chronic inflammatory state that can lead to an early capsular contracture. Speak with your surgeon at length about this. I think most surgeons would agree that all things being equal, the inframammary crease incision is preferred.Best Wishes,Dr. Morrissey
Breast Augmentation Incision
Hello,Reconsider. Periareolar incisions are enjoying a reputation they don't deserve here in California. There is the pervasive thought that it is the most inconspicuous, most aesthetically pleasing incision available. It is not. 16 years of specialization in revision breast augmentation and I can honestly say that on average, it is perhaps the most conspicuous, unaesthetic scar that can lead to breast mound deformities, tethering of the areola, and thickened and dark scaring. Worse than all of this, it is the incision that puts you at the highest risk for capsular contracture. And to my knowledge, your areola is your 'actual breast'.The inframammary incision is the most often used incision in the world. It allows the surgeon to place an implant with the least amount of trauma to the breast tissue and muscle, and avoids milk duct injury, the cause of the increased risk for capsular contracture (bacteria). It is more aesthetically pleasing than the areolar incision by far, even in darker skinned individuals, and will never cause breast mound or areolar deformity due to scarring. Best of luck!
Peri-areolar incision for augmentation
Thank you for asking about your breast augmentation.
- Your healing and pain should be the same, whatever the incision.
- The peri-areolar incision usually looks excellent.
- However there is a move away from using it because there are more bacteria in the area and because it can be harder to get modern gel implants in through this incision.
Always see a Board Certified Plastic Surgeon. Best wishes - Elizabeth Morgan MD PHD FACS