Breast implants through the areola. Is it safe? What precautions can I take to prevent CC? (Photo)

Dear evangeline jamie,
I tend to prefer the periareolar incision because its the most well hidden. There is a natural border between the areola and the rest of the breast skin the hides the incision extremely well. You have to be completely naked to see it vs other incisions like transaxillary and inframammary are visible in clothing such as sleeveless shirts and bikini tops when extending your arms up. I've also noticed increased rates of bottoming out with inframmary incisions that is not reported. Transaxillary implants are always wide in appearance because the surgeon is not able to dissect medially enough to provide better cleavage. Ultimately, I can perform any of the incisions but I recommend the periareolar. There is no difference in sensation because the nerves that control nipple sensation come in laterally from the back and injury to them occurs when surgeons dissect to far laterally which is why transaxillary incisions have the highest nipple sensation disruption. There is no difference in breast feeding ability. One study did show a slight increase in capsular contracture with use of periareolar but that study was small and did not incorporate modern techniques such as below muscle placement, keller funnel usage and triple antibiotic irrigation.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

With bottoming out, you need to go smaller, not bigger. Your tissue has stretched and thinned and is not supporting the weight of your implants well. You also may need mesh. I would use the same incision as before to avoid two scars on your breast. Plus, this incision will be easier to use to repair your inferior pocket.

Breast implants can be placed around the areola incision. Saline implants are particularly easy to place through the areola. However, silicone implants may be more difficult because the width of the incision is limited. Your implants have bottomed out. An alternative to consider is to use your old incision. Use this incision to reinforce laterally and inferiorly as well as to dissect higher and more medial.

Best Wishes,

Gary Horndeski, M.D.