Under what circumstance would a Dr. deviate from original plan? Decision made during surgery to do 2 incisions vs.1. Why?(photo)

Waiting to get a call back from my Dr. But in meantime, curious how other doctors do it. As patient, feeling some confusion & even disappointment. The plan was peri-areaolar mastopexy/augmentation. 330cc Implants under the muscle and via nipple incision (to minimize scars). A big reason I agreed to peri-areolar incision was for lift and 1 incision site. Otherwise, I would have just done implants via the inframmary fold (w/o any damage to nipples). Why would a doctor do both when we agreed on 1?

Doctor Answers 9

Two incisions

you will definitely have to get this information from your surgeon. The comments so far are accurate but only the operating surgeon can answer this question. Hopefully you will have an excellent outcome. 

Nashville Plastic Surgeon
4.9 out of 5 stars 52 reviews

Go to the source!

Hi mcbeth32, Definitely speak with him, of course only  he knows why he did what he did. My first thought is the areola was incision was not large enough to fit the implant, so a secondary incision site was created to safely do the surgery. However, there could be a few reasons. Regardless the reason, try to stay calm and relaxed, it's important for a good recovery from surgery. I would not be worried about any damage to your nipples. The scars in this area tend to heal very well and be hardly noticeable. Best of luck to you, I am sure you will be fine!

William Aiello, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 48 reviews

Change of plan

Hello, sorry for the issue... only your PS can answer why they choose to do what they did...but a few reasons why could be... -Simply could not see enough to do the operation safely-Could not fit the implant in through the incision-Had bleeding that they could not control from the first incisionOther possibilities could be present. I would just ask your PS to know for their reason. 

Paul W. Papillion, MD
Nashville Plastic Surgeon
5.0 out of 5 stars 58 reviews

Two Incisions

Placing the implant through the  nipple instead of just using that incision for a lift can carry a variety of increased risks. This would have been discussed and noted before your surgery though. I recommend that you discuss your details and concern with your Plastic Surgeon so that they can explain for you.
All the best

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Breast Augmentation - Post Op Concern - 2 incisions?

Thank you for your question. I'm sorry to hear of your frustration. It is quite possible your surgeon needed a larger incision (in the fold) to place your implants. It is best to have this discussion with your board certified plastic surgeon to better understand what happened. Hope this helps.

Steven J. Rottman, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 78 reviews

Talk to your doctor

Your doctor will be able to fill you in on the reason.It could be that it was difficult to place the implant through the infra-areolar incision.

Keith Denkler, MD
Marin Plastic Surgeon
5.0 out of 5 stars 18 reviews

Implants and incision

This is an issue that you should talk about with your surgeon.  Sometimes a second incision needs to be used. Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Breast augmentation - why two incisions

Thank you for asking about your breast augmentation.
  • I am sorry this happened - when the possibility exists it is usually discussed in advance.
  • If you have gel implants, it is possible your surgeon couldn't get them in through the small peri-areolar incision.
  • Modern gel implants are thick and don't compress - at times a larger incision is need to to get them in place.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

One Incision vs Two?

Many surgeons prefer to place the implant through an inframammary approach, even if they are using a circumareolar incision for a small lift.  The reason is that the published nationwide complication numbers are always higher when you have placed the implant through the nipple areola approach as opposed to the inframammary approach.  When you place the implant through the nipple areola, you have to dissect down through breast tissue to get to where the pocket needs to be created.  This stirs up more bleeding and natural bacteria from the milk ducts, which can then lead to higher capsular contracture rates over time.  The lift itself does not violate any breast tissue, so you are essentially keeping the breast tissue intact while working above and below it.  If your surgeon did not explain this to you beforehand, then certainly ask them for their reasoning.  However, know that this is the trend more and more these days in order to limit potential long term complications.  I hope this helps.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
4.8 out of 5 stars 73 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.