Is going through the areola for implant necessary if you are also having areola reduction?

I am getting silicone implants and I want an areole reduction. I have read that the possibility of capsular contraction is higher through the areole incision. Is there a way to go under the breast fold and then do the areole or would that not make sense? I am back and forth on the areole reduction for this reason. I want it done but not if it will make capsular contraction a higher chance for me. I have just always hated the size of my areole and my Doctor said he does do the reductions.

Doctor Answers 11

Breast Incisions

You have asked an excellent question.  You are correct to be concerned about the increased capsular contracture risk when placing an implant through the areolar incision.  My approach is to place the implant through an inframammary incision.  After the incision has been closed I will then proceed to do the areolar reduction.  Depending on the size of your areolae and the size of the implants there can be significant tension on the areolar closure which might result in the areolae stretching again.  You should speak with your surgeon about this concern and the advisability of performing the reduction as a second procedure vs. the downside of having two surgeries.

Saint Louis Plastic Surgeon
5.0 out of 5 stars 81 reviews

Consider staging your surgery

Placing a breast implant will put tension on the breast skin.  Reducing the size of the areolae also puts tension on the breast skin.  Doing both at the same time might cause the reduced areola to enlarge as the tight breast skin pulls on the areola.  Consider having the breast implants placed in one stage using any incision you prefer (I generally recommend the armpit incision with the implant placed beneath the pectoralis major muscle) and reducing the areola at a second stage.  The skin tension from the augmentation will have subsided and if there is any post augmentation asymmetry of position of the areola that can be improved when the areolae are reduced.

Donato A. Viggiano, MD
Port Saint Lucie Plastic Surgeon
5.0 out of 5 stars 3 reviews

Areolar reduction

The risk of capsular contracture from a periareolar incision needs to be balanced with the risk of a malpositioned scar in a small breast without a well defined inframammary fold.  Since the risk of capsular contracture is multifactorial, it is the surgeon's role to decide how to minimize the risks and optimize the results by accepting some risk factors and avoiding others.  Best wishes, Dr. T. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 52 reviews

You can absolutely reduce the areola and make the incision in the breast crease

Most patients prefer just the one incision around the areola but I have at times made an incision in the crease for implant placement and then reduced the areola with a Circumareolar incision. It can definately be done. I hope this helps.

Itzhak Nir, MD, FACS
West Palm Beach Plastic Surgeon
4.9 out of 5 stars 39 reviews

Is going through the areola for implant necessary if you are also having areola reduction?

I agree with your concerns about capsular contracture when the implant is placed through the areola.  I always use the inframammary crease incision unless of course a dermal mastopexy or lift is being done.  One possible solution is to have your breast augmentation done through an inframammary crease incision and after 6 months have an elective areola reduction  that avoids incision into the breast glandular tissue or ductules.

Do I need to go through the areola to do an augmentation if I need an areola reduction as well?

What a good question!  I feel the same way that you do about not wanting to go through the areola to do a breast augmentation.!  I will do a nice areolar reduction as must be needed as you describe, but do not dissect through the  breast to perform the augmentation- this will be done through the safer inframammary incision.  An areolar incision has been shown to have a much higher frequency for developing a capsular contracture surrounding the implant( with an increased infection potential). Insist on doing what you know makes sense to you.  Discuss this with your chosen Plastic Surgeon.

Good luck to you.

Frank Rieger M.D.  Tampa Plastic Surgeon

Areola reduction and implants

It would make sense to limit the incisions if one is also having an areola reduction.  You probably do not need an inframammary incision as well.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Is going through the areola for implant necessary if you are also having an areolar reduction?

Thank you for sharing your excellent question.  It is possible to use two different incisions for your procedure - a breast crease incision for placement of the implant, and a periareolar incision to reduce your areola circumference.  The benefits of two incisions is in limiting the possible bacterial colonization of the implant by going through the areola but at the cost of two scars on the breast.  Alternatively you can perform the areolar reduction in a second stage after you have healed from the augmentation.  Talk to your surgeon about your concerns. They should be able to best advise you.

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 68 reviews

Can implants be placed through the IMF and still reduce the areola?

Absolutely!  While most patients are worried about extra scarring, you are correct that the best way to reduce risk of capsular contracture, according to recent studies, is an IMF approach. And then yes, you can have an areola reduction with a second scar. Talk to your surgeon, he is probably thinking that you are like most patients and are more worried about external scarring than capsular contracture.  Personally, I think you have your priorities straight. Best is luck 

Melinda Haws, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 45 reviews


Both are options- a separate incision under the breast for the implants and an areoalar vs doing both from around the areole. Personally, I do not cut through the breast tissue with this approach- that may cause increased capsule and other issues. It also depends on the size of your areolae and the implant size as well as surgeon preference.

An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.

Harry T. Haramis, MD, FACS
Montclair Plastic Surgeon
3.7 out of 5 stars 19 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.