Periareolar incision vs inframammary... which is best?

There are two types of scarring to be aware of: internal scarring (capsular contracture) and external scarring. All breast augmentation incisions have their pros and cons. If you do not have a small areola then a periareolar approach is reasonable and the scar is more camouflaged. However you should be aware that there is a higher risk of capsular contracture and not being able to breast feed with this approach. A transaxillary approach also has a higher risk of capsular contracture and has no breast scars. An inframammary approach would probably be the safest with least risk of complications with the scar tucked beneath the breast to hide it. Hispanics/Asian/Mediterranean, and African American populations have more of a tendency for raised scars/keloids.

I believe that periareola incisions and non-Caucasian women can be an issue because they can be readily seen. I usually recommend a periareola incision for Caucasian women with a larger diameter areola. Capsular contraction can theoretically be greater with a periareola  incision because you have to operate through the breast to get to the muscle. This can increase the amount of bacteria that the implant comes in contact with. Capsular contracture is believed because by a low-grade bacterial infection.Earl Stephenson Jr MD DDS FACS 

This is an age old question in plastic surgery and there's lots of opinions and not much science. I see a lot of breast cancer patients, so my current thought process is the less we disturb the breast tissue the better. That is not to say that inserting the implant has anything to do with breast cancer but an implant placed through and inframammary incision can be done almost without even touching any breast tissue. It's hard to say that about a peri-areolar approach.

While there are advantages and disadvantages to both types of incisions, both incisions provide direct access with good visualization for proper placement of the breast implant for the surgeon.  Typically, the peri-areolar incision has a slightly higher rate of capsular contracture and change in nipple sensation; however, the scar is usually well-camoflagued in women who have a distinct change in skin tone between the areola and skin.  The inframammary incision is typically well-hidden at the inframammary fold.  In terms of scarring, the only way to know how you will heal is based on the appearance of your scars from previous procedures.  I would recommend that you consult with a board certified plastic surgeon to discuss which option is best for you.  Good luck!

Hello, I'm Dr Matos from the Dominican Republic, the best is the periareolar incision, because leave a better scar and give to us a best way to introduce the implants, the capsular contracture doesn't have relationship with the way that we used for introduce the implants, and the patients either, if it related with the place where we put the implants, it's more comun if we put the implants behind of the glands, that's why i recomend put the implants behind the muscle.

Thank you for your question and you can already see from the responses there is no consensus.  Generally speaking darker skinned individuals may form a dark scar so the periareola incision may hide better though either approach including axillary are good  in the right patientDr Corbin

I have used all the incisions to place breast implants including through a tummy tuck. I still prefer the peri-areolar one for the scars heal the best in most cases. I see ones that I have done years ago and sometimes it is hard to find the scar! The inframmamary one is good but in about 20% of the cases, the scar may not heal well and then if the swimming suite rides up and/or the bra it is visible and nothing can be done to erase it! Unfortunately, some unscrupulous doctors will tell patients that they will lose more sensation, not be able to breast feed, have longer recovery, greater chance of infection with the peri-areolar incision but that is just not true. They probably say this because they do not know how to do the other techniques!?

The lowest rate of capsular contracture is to have the augmentation completed through an inframammary incision.  There is a six times higher incidence for capsular contracture when an augmentation is performed through a peri areolar incision.  Discuss this with your localPlastic Surgeons if you have further questions about this.Good luck to you.Frank Rieger M.D.  Tampa Plastic Surgeon

There is no data that would indicate a difference in capsular contracture rate between different ethnic groups. There is data that says that the capsular contracture rate is less with the inframammary incision. Also, that incision is less likely to result in a late implant rupture when a large implant is used or the size of the areola is small. This is especially true with textured implants. There should be no difference in the resultant scar if the incision is closed properly.

Both periareolar and Inframammary incisions can give better resultsVisibility during surgery and accuracy of placement of the breast implant is better with Inframammary Crease incision.Silicone Gel Breast Implants almost always require an Inframammary incision except for small 200-250cc implants.A recent study did find that capsular contraction is less after the inframammary crease incision.Some Hispanic scars can pigment darker but pigment can be lightened.