Advantages/disadvantages to periareolar insicions? (photo)

Thanks for the question.  My preference is to do the incision in the breast fold.  This approach allows the most direct access to developing the pocket for the implant, it avoids disruption of the breast gland which can lower the risk of capsular contracture, it avoids cutting nerves right at the areola which can decrease nipple sensitivity, it can be made large enough to allow placement of a large silicone implant, and it tends to be a very inconspicuous scar because the only way patients see it afterwards is by lifting up the breast.  The periareaolar incision is very useful in the properly selected patient.  I use this incision in patients that have an indistinct breast fold who want a fuller look.  This often requires a saline implant because the incision cannot be made large enough to use silicone.  The periareolar incision is also used for patients with tuberous breasts--breasts with a tight lower pole, indistinct fold, and herniation of the areolar tissue.  In these patients I'll use the periareolar approach because I can release the tight pole and correct the areola deformity best that way.  I hope this helps.

The peri-areolar incision usually heals quite well, but has a higher risk of infection and difficulty in breastfeeding. Nipple sensation may also be at risk. However, it has not been associated with a higher risk of cancer detection, or developing cancer.To determine the most suitable incision placement, it's best to see an experienced board certified plastic surgeon for a physical examination.

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 inframammary approach would probably be the safest with least risk of complications.

I prefer to use a periareolar incision because it allows a
simultaneous lift at augmentation.I
recommend a new technique called Breast Augmentation 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, implants can be placed.Aligning the areola, breast tissue and implant over the bony prominence
of the chest wall maximizes anterior projection with a minimal size
implant.Small round textured silicone
gel implants placed retro-pectoral look and feel more natural, are more stable,
less likely to ripple or have complications needing revision.Implant profile is irrelevant in the
retro-pectoral position since the muscle compresses it.450 to 475 cc implants are large, will not
fit retro-pectoral, will extrude inferiorly and laterally requiring
revision.Best Wishes,Gary Horndeski, M.D.

The advantages of a periareolar incision are that the scar heals nicely in most patients and is easily concealed under any bikini (with a top).The disadvantages of a periareolar incisions are:1.  if any amount of scar deformity occurs, it is on the front of the breast2.  a possible increased risk of loss of nipple sensation3.  a possible increased risk of inability to breast feed in the future4.  the size of the areola may limit the size / style of silicone implant that can be used5.  several clinical studies have been published that have found an increased risk of capsular contracture with periareolar incisionsI would recommend that you consult with board-certified plastic surgeons experienced at breast augmentation who can review the different options as well as the risks and benefits of each, to help you decide the best way to achieve your goal.Best wishes.

The main advantage is the ability to hide the scar well in most patients around the areola. More recent studies support a higher risk for capsular contracture with the periareolar approach. Its also slightly more difficult to get a silicone gel implant or cohesive implant into the pocket.  The upper areolar incision can be used to elevate the nipple areolar complex in some patients with mild ptosis. 

I favor the periareolar incision because it usually heals so well and the scar is well-hidden.  The disadvantages of the incision are possible increased risk of not being able to breast feed and loss of nipple sensation.  Some believe that it also increases the risk for capsular contracture as well.  The risks are still small and you have large enough areolas to have implants placed through them.  

I would be willing to place your implants through a periareolar incision. My argument against it has to do with a theoretical possibility of contamination of the breast implant as it is dragged through breast tissue that might lead to capsular contracture by way of a biofilm. At the moment however this is theoretical.

Great question that all 14 experts have given you insight into. Best to face to face discuss with your chosen surgeon... 

I only use a per-iareolar incision because of the ability to control the operation and then as mentioned below if there are any issues down the road an infra-mammary incision is used to correct the problems.