What is the Best Incision to Use to Maintain Nipple Sensation with Implants?

I have decided on Allergan 410FF 375 or 410FM 350 implants under the muscle. To avoid double-bubble I need a lift. The PS (very experienced) says he can insert 410 style implant through periareolar incision and perform crescent lift. I don't care about scars too much. I am worried about nipple sensation and blood flow. Would a full anchor lift with IMF placement of the implants make sense?

Doctor Answers 10

Lift and augmentation

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I think a circumareola aug lift will be OK. I do not think the specific incision method affects the sensation.  I think it may be more due to the size of the implants used.

Multiple issues including nipple sensation

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I would agree with the first response that your "experienced" plastic surgeon doesn't sound too experienced to me. I would condemn the use of both "crescent lifts" and periareolar incisions to put in breast implants and a lift will not avoid double-bubble contour problems. 

There are multiple issues here that need defining and response. The first is the need for a lift. It is not possible to judge this from the picture because it is not apparent where the inframammary crease lies in relation to the nipple. If the nipple is more than two centimeters below the level of the inframammary crease in its forward projection, then a lift is the only option and it must be done properly to truly lift the breast and get it to heal in the elevated position. In my experience this requires a true mastopexy done with a periareolar incision and a vertical incision from the bottom of the areola to the crease. This is called a lollipop incision. An anchor incision is not needed but a periareolar or donut incision will usually not get the breast lifted properly or if it does it probably didn't really need to be lifted. I would also do the mastopexy first by itself and then see if an implant is still desirable although the two operations can be done at the same time. Additive risks including blood flow problems go up in combined procedures. 

If the nipple is not too low relative to the inframammary crease level, than an augmentation with an implant can be done and I would recommend a properly fitted low or moderate profile round implant (in gels these are called different names). This will fill in the upper pole (scallop), expand the lower pole (below the areola) of the breast which makes it look lifted even though it filled out rather than up. This is best done through an inframammary incision and should not affect the breast or sensation. The incision length can be two centimeters for a saline implant and three to four centimeters for a third generation gel (using a new device to "funnel" the implant in through a lesser incision). 

In general, the risk of losing sensation to the nipple is low even for a lift or periareolar incision but avoiding the area entirely would seem to offer less chance of affecting nipple sensation. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Breast augmentation with 410 implants and a mastopexy (breast lift): what incision?

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I would say your "very experienced" breast surgeon may need more experience, in that from your photos it would appear that you need a significant lift, either vertical or "t-type", and make sure you are included in the 410 study as these are still experimental devices. The thinking that an implant will provide a lift is false and incision type effects sensation is false. Nerve preservation with pocket dissection for the breast implant is the most important step. I would consider seeing a board certified plastic surgeon with experience in mastopexy-augmentation surgery rather than trialling unapproved devices.

Nipple sensation with breast lift and breast augmentation

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The risk for a change in nipple sensation with breast augmentation is about 15% regardless of the incision used.  The nerves to the nipple travel from between the ribs through the breast tissue  to the nipple-areolar complex. There are no scientific papers that conclude that any incision is more risky than the others, and the mastopexy incisions will not add to the risk.

I am not impressed with the results from crescent mastopexies.  I think you would need a peri-areolar mastopexy at the very least.  However, I completely disagree with the statement made by one of my  colleagues that the anchor lift is never appropriate for a breast lift.  When there is a tremendous amount of redundant skin, especially after weight loss, anchor lifts are necessary.  Never say "never", and never say "always".

Anchor scar never indicated for breast lift.

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Crescent lift doesn't do much, and anchor scar is not appropriate for breast lift (only for extreme breast reduction). 

From your picture. I think you need a "doughnut" lift with a scar around your nipples.  With good technique, nipple sensation is preserved.  I would also recommend somewhat smaller smooth walled breast implants over the muscle.  This would probably give yo the best long term shape.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Best incision to use to maintain nipple sensation

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Great question. I recommend either infra mammary or axillary incision to preserve the nipple areolar sensation. It seems to be the best way to protect the tiny nerve endings areound the areolar nipple complex.

From MIAMI Dr. B

Sensation after Augmentation/Lift

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Since neither lift method does anything other than remove skin and tighten the skin around the breast (and implant), neither will cause loss of sensation. The one thing that has been shown to cause sensory loss in these procedures is the size of the implant base. The larger the implant base, the greater the loss of sensation. The size you have chosen appears to be reasonable for your frame. You should, therefore, have minimal sensory loss. Everyone has some, but studies have shown that, even with a measurable loss, most people do not notice the loss at a year.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Incision to Maintain Nipple Sensation

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Neither the crescent lift nor the anchor lift incisions should pose a significant rick of loss of nipple sensation.  In my experience there is little difference in the incidence of loss of nipple sensation with periareolar or inframammary incisions for augmentation, both of which are around 3-4%.

John Whitt, MD (retired)
Louisville Plastic Surgeon

What is the Best Incision to Use to Maintain Nipple Sensation with Implants

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You have two questions to answer; 1) the choice of incision generally is not related to loss of nipple sensation but more ot implant size and 2) the use of a crescent lift is only for slight 1-2.5 cm corrections. I would really need measurements to assess your nipple in relation to your crease.

Breast reshaping and implant incisions

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Hit here-

I would seek at least one other opinion from plastic surgeon very experienced in breast surgery.

My concern is that you will be unhappy (based on your photos) with an attempt at a lift don around the nipple- and once done this is impossible to correct....

With regard to implant placement, I believe placing the implant through an incision far from the nipple is the best way to prevent loss of function, among other problems.

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.