Nipple incision vs crease incision? What are the pros and cons of both? I'm going for 500-700 cc.

Hello,
We plastic surgeons have a strong tendency to please, to the point where we might even do what you want despite exposing you to unnecessary risk.  So we give lots of options as though they are all equal. The reality is that in 2017, we are finally drifting towards 'evidence based best practices', like all other medical specialties (imagine if a cancer doctor offered a variety of chemotherapy meds to a patient with cancer, some with better known outcomes than others!).  What this means for you is this: there is only one incision that will minimize your risk for not only the most common complication (capsular contracture), but also the least common complication (breast implant associated anaplastic large cell lymphoma), and that is the inframammary incision. It is the most common incision around the world. It is a myth that the periareolar or nipple incision is more cosmetically pleasing; on average it is actually more conspicuous, and it is frequently associated with other scar related breast mound deformities, like areolar tethering and flattening of the lower pole of the breast. Although you'll still find an abundance of surgeons who offer it (remember, they don't want you walking out their door without you booking surgery), you should say no to nipple incisions. Best of luck!

Thanks for your question,I personally prefer the breast fold incision or inframammary incision because is hidden in the breast fold and has a much lower incidence of capsular contracture that the nipple incision. Also, this approach allows introducing big sizes like 500 or 700cc if you are planning to use silicone implants. Also to breastfeed in the future the inframammary incision is ideal because will not violate your milk ducts and breast tissue as the periareolar incision can. Please make sure to contact a Board Certified Plastic Surgeon.

The choice of incision in the setting of breast augmentation is one which is made jointly by both the patient and the surgeon. Surgeons typically have their preference as do patients. 
Your options include-
The DIRECT approaches:
-IMF (fold)- (+) popular, direct access with good visualization, if placed appropriately it is well tolerated and well camouflaged; (-) the scar can migrate as the fold descends with augmentation, the incision can be misplaced
-Infrareolar- (+) commonly used alternative to the IMF incision, the location is more consistent and predictable than the IMF, especially useful in those patients with a poorly defined fold; (-) there is a limitation based on the size of the areola (smaller areolas will limit incision size and thus impact visualization), this technique is also associated with slightly higher rates of contracture (due to the contention that there is low grade contamination associated with passage through breast tissue).
The INDIRECT approaches:
-Transaxillary (armpit)- (+) avoids a scar on the breast mound but must be performed endoscopically as there is no direct visualization of the pocket during dissection otherwise; (-) can be limiting with regards to implant size and type (although the Keller funnel has helped); saline is preferred, however, smaller silicone devices with a funnel are possible; form stable implants cannot be placed via this indirect route.
-Transumbilical (belly button)- (+) avoids a scar on the breast mound; (-) no direct visulization of the pocket, saline implants only.
The direct approaches remain the most popular with the IMF approach most commonly used. The incision choice has very little impact on pain or recovery (this is more a function of augmentation plane). Augmentation, irrespective of access incision is likely to distend the areola to some degree (this is more a function of implant size).
Ultimately, no approach is perfect. They are different as is each surgeon. The incision decision is best made in concert with your board certified plastic surgeon (ABPS).

The periareolar incision (nipple) heals quite well however is associated with a higher incidence of capsular contracture, which is a type of scar tissue that can form around breast implants causing them to become hard and distorted. The inframammary incision (crease) is hidden in the breast fold and has a much lower incidence of capsular contracture. If you are planning on future pregnancies and breastfeeding, the inframammary incision will not violate your milk ducts and breast tissue as the periareolar incision can. You can ask these questions during your consultation and your plastic surgeon will be able to go into much more detail at that time.Best wishes,Dr.Bruno

Nipple areolar incisions can work well in patients with an areolar diameter that can accommodate the size of the implant to be inserted.  It is easier if those patients have thinner natural breast tissue mass as the tunnel is not so long.  It can also make for a less obtrusive scar when patients lack a natural well defined IMF.  There is some suggestion that infection rates and breastfeeding issues are higher with incisions in the nipple area.
I personally favour a IMF (fold) incision in most patients.  The incisions and scars are well hidden in the fold in most cases where such a fold exists prior to surgery.  One can completely avoid the breast tissue and this can impact breast feeding and infection rates.  The fold accommodates a wide range of incision lengths well.  In the case of any complications such as infection, bleeding and capsules, it is easier to manage through the IMF approach.
In your particular case, a 500-700 cc implant is on the larger end and generally requires longer incisions.  This is generally better in the IMF in most patients.  I personally use Keller funnels to minimize incision length.  There is some suggestion that forcing implants through too small an opening in the breast can weaken the shell and lead to premature implant rupture and failure.
In the end, if you heal extremely well, it does not really matter where the scar is positioned.  If the scar is destined to be red or hypertrophic for a while, then an IMF location is the best hidden until things settle down.

I don't like problems.  the likelihood of problems is higher with areolar incision. so I prefer the inframammary  good luck

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  The best incision depends on your individual breast size and shape.  Both incisions can work well in most patients.  If you have small areolas, then an inframammary incision is better.  Inframammary incision also has the lowest infection risk   The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Dear serrinaahley,type of incision is in most cases surgeon's preference. We specialize in minimal scars. Its starts with a peri-areolar incision that hides the scar at the border of the areola. Next, I close my incisions in 5 layers and take stitches out week one and week two.  I don't recommend absorbable sutures because they cause inflammation that worsens scars. Then we tape your incisions once a week for 6 weeks. Lastly we start you on a 3 month topical scar management protocol with a scar gel thats FDA approved. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

There are criterias for choosing either one. First of all, there are no nipple incisions but "Around the Areola" incisions, and "Crease Incisions" technique for implant placement, among others. I usualy choose the crease incision (that is not perform rigth in the crease but a litle bit higher)  when the Nipple-Areola complex is very small to avoid any harm or insensibility to this delicate tissue due to a very tiny size.

Hello. Thank you for your inquiry.

It is important to have an in-person assessment regarding your concerns as it is difficult to determine virtually.
There are many different factors that go into choosing a breast implant size which will correspond with your body dimensions while concurrently achieving your aesthetic results. Some of these factors are: Implant size (CC's), Implant profile (Low, Moderate, High), Placement of the implant (Subglandular vs. Dual Plane) etc. We utilize smooth round cohesive silicone gel 'gummy bear' implants for the best results.
During a consultation your aesthetic goals are heard and taken into account with the measurements of your breasts and the integrity of your tissue, as well as level of ptosis (sag). From here we collectively can find your 'perfect fit'. You are able to try out sizers and different implants in our office such that you can get an idea of what size you would be post-operation. We also offer Crisalix 3D plastic surgery virtual simulator during our in-person and virtual consultations to preview potential results. After your consultation, you will receive your very own implant sizers to take home with you (at a small cost) whether or not you decide to go forward with your procedure.
I usually recommend that my patients stop smoking, take vitamin C daily, and avoid aspirin/ibuprofen and vitamin E 3 weeks prior to surgery. I specialize in the 24-hour Recovery method which minimizes trauma to the breast and decreases pain post-operatively.
We encourage you to look at our website and Instagram (drkaraplasticsurgery) for lots of before and after pictures!
Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.
During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery.
We invite you to come in to discuss your options more thoroughly. Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!

M.Kara,MD,FRCSC (27+ years experience) - Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind