Had a breast augmentation using areola incision. The scar caves in only when my breast is touched. Is this common?

Question

Is this common? And is there a solution? I’m not poking it in a way that would specifically make it cave in. I’m just cupping it softly. Thank you

Brent Moelleken, MD · Answer

One of the disadvantages of a periareolar incision, especially if a redo surgery is also performed through the same incision, is that there can be a depression due to scar contraction.  Sometimes this shows up as a shortening of the nipple to bottom of the areola distance, or a downward pointing nipple.  This typically worsens with subsequent surgeries.  There are ways to correct it, but the problem is quite significant and reaches all the way down to the implant.  It isn't confined to just the nipple.
That's why I prefer an under the breast incision in most patients.  This does not require any alteration of the nipple-areolar complex.
There are ways to minimize this issue but I have seen it occur often, even in the very best of hands.

Stephen M. Krant, MD, FACS · Answer

From the photos, there is scar tissue creating the indentation at the underside of the nipple areolar complex. This can be corrected with excision of the scar and release of all of the scar tissue that is pulling the aerola down ("caves in").
Steroid can be injected at the end of surgery to decrease the aggressive scar formation. Also, post-op, the area can be treated with massage and ultrasound to decrease the possibility of further scar and adhesions.

Gerald Minniti, MD, FACS · Answer

Hello,
My colleagues want to ensure that choices can be given to potential patients, and frequently present them as equal choices. However, when it comes to incisions, they are not all equal. Periareolar incisions put the patient at a higher risk for capsular contracture, scar tethering (what you have), and breast tissue atrophy.  With time your scar may soften, but it may not. However, any further breast implant surgery should be performed through inframammary incisions, the safest route. Best of luck!

Farbod Esmailian, MD · Answer

That is certainly an issue that can happen with breast augmentation through an areola incision.  It depends on how long you are out from surgery.  If you are early within a year, then there may be hope with aggressive massage of the scar to help breast it up and detach it from the underlying tissues.  In some patients this will work in others it may not.  This issue can in most cases, but not all, be avoided if the incision is closed in multiple layers.Hope that helps.

Daniel Barrett, MD · Answer

Dear Lucinda1234,I understand your concern. However, without a proper assessment it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment. Only after thorough examination you can get proper recommendations and advice.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Johnson C. Lee, MD · Answer

Thank you for your photos. Incisional scars have collagen which are not produced in parallel to the rest of the normal skin. This causes the skin to buckle or fold in the scar under pressure. Sometimes there is also adherence of the scar to the underlying tissue. This is difficult to restore but some procedures such as fat grafting and other collagen remodeling devices (microneedling/lasers) can make the depression much less noticecable. Hope this helps!Johnson C. Lee, MD 
Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Tim Sayed, MD, MBA, FACS · Answer

Most of the time this does not happen, assuming the soft tissue of the breast has been reapproximated in layers, but it is always a risk. Part of the issue is that the periareolar augmentation incision, while aesthetically nice from a scar perspective, includes division of the breast tissue all the way down to the muscle, so the cleft in the tissue extends all the way to the implant pocket. With big implants, the soft tissue is squeezed and the scar can indent the seam. Correction might include fat grafting, use of dermal matrix or other products to try to fill the gap, but if the problem is only present when squeezing the breast and not visible at rest, it may not be worth the risk of infecting/injuring/exposing your implants to try to correct.

Milind K. Ambe, MD · Answer

Thank you for your photos and question.  Unfortunately this can happen with this incision site.  Speak with your doctor and see if they recommend any massages or medications that can help with your case. Sometimes ultrasound can also help.  Best of luck to you.

Eric YK Li, MD · Answer

There is scar tissue from where your peri-areolar wound is to the base of your breast, as this was the access used for your breast augmentation.  The scar tissue is the reason why you are seeing puckering of the area with manipulation of your breast.  If it isn't bothersome, I would suggest leaving it alone, but if it is bothersome, a minor procedure can be done in the office using a needle to release the tethering scar tissue deep to your scar.  This will likely improve the appearance of the puckering but not make it go away completely.  Hope this helps!

Had a breast augmentation using areola incision. The scar caves in only when my breast is touched. Is this common?

Answers (9)

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