Periareolar incision vs inframammary incision?

Thank you for your question. In terms of the result that can be achieved, there is really no difference between the two approaches. Each has its own pros and cons. The advantages of a periareolar incision is that the scar is very well hidden at the bottom of the areola. The disadvantage for the surgeon is that it is a little more difficult to perform, because the incision is generally smaller. In addition, there is a theoretical disadvantage with periareolar incisions, that there may be an increase in the rate of capsular contracture due to contamination of the implant due to contact with the milk ducts. However, most surgeons now use a Keller Funnel, which is a sort of sterile plastic bag that delivers the implant directly into the pocket without contacting the areolar tissue. This should minimize the increased risk of capsular contracture. I prefer to use a periareolar approach for all my breast augmentations, but I believe patients can get an equally good result using either periareolar of inframammary incisions, regardless of their starting anatomy. I hope this helps.

Yes, I agree with you. I always prefer inframammary incision for a breast implant surgery.You can correct the natural droop in the way you approach the surgery even through an inframammary incision. I do not prefer a peri-areolar incision as it increases the chances of capsular contracture. In peri-areolar incision, you go through the lactiferous ducts. Hence inframammary incision is gold standard in my eyes.

As you mentioned the periareolar incision poses a higher risk of capsular contraction than the IMF.Any substantial lift will result in scars. The surgeon you select should be so skilled at breast surgery and lifts that the smallest scar will be utilized to achieve optimal shape. The IMF incision allows the surgeon to avoid milk ducts and loss of sensation.

Unfortunately, you have not provided photographs but a periareolar incision can be used to lift your breasts as well as place the implants. This technique excises a donut of skin and the implant can be placed through the non-areola portion of the excision, which is less likely to lead to capsular contracture.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question. I always recommend a inframmamary incision. Reason being they tend to heal very well, lower chance of capsular contracture, lower chance of nipple sensation loss, breast feeding complications tend to be lower and if there is going to be a scar it's typically hidden very well. I would suggest speaking with your surgeon in detail about your concerns and making your decision. Best of luck to you.

Thank you for sharing your question. I'm not sure where your surgeon obtained that information but in most cases the crease incision is preferred as it is a "cleaner" site for placement.

I think most plastic surgeons agree that the incision through the areola has a higher risk of causing capsular contracture, which is already one of the most common reasons women need secondary breast surgery. Further, if your scar is thick, colored, or widened, it will be readily visible.

The only reason to place an incision on or around the areola, in my opinion, is if you plan on changing it: i.e. reducing it's size, changing it's shape, or lifting it.

Periareolar incisions place women at the highest risk for capsular contracture and other scar related deformities of the breast mound. There is no breast shape that makes the inframammary incision not the best, least traumatic, and lowest risk way of performing breast augmentation. If you have to convince your surgeon to use the evidence based best incision, you should find another surgeon; what else is he not doing during the surgery to limit your risk of problems, capsular contracture or otherwise?

Thanks for your question. Your plastic surgeon is your best resource, but if you are not entirely convinced, ask questions or get a second opinion. The inframammary incision is what most plastic surgeons use, and there is good evidence to support that decision. Your research has raised some proper concerns. without an examination or photos it is difficult to comment on your specific case. Do your research, take your time, and use photos of women's breasts you deem beautiful and share those photos with your plastic surgeon. Best of luck to you.

HI Polite,

It is difficult to give you informed advice without photos. With that said, I think that an IMF incision has a better chance for you to keep feeling on your nipple-areolar complex. and also the ability to breast feed in the future, if you wish.
Furthermore, your breasts may have more than a natural droop after a peri -areolar incision . The IMF incision can help give some support to the bottom pole of the breast.
In any case, discuss this with your surgeon or seek a few more consultations in your area.

Good luck and best Wishes,

Dr. Christine Rodgers