What are the risks of a periaerolar incision?

The periareolar incision (under the nipple) for breast augmentation and placement of breast implants is not as common as an incision choice as the lower breast fold or infra-mammary fold incision. The incision is curved under the border of the nipple pigment and actually heals very well. There may be a theoretic increased risk of capsular contracture secondary to bacterial contamination of the breast implant because of the close proximity to the nipple ducts, both internal and external. This can be lessened by protecting the implant from the nipple on insertion and a careful dissection plane down to the implant pocket. This incision, in my hands is utilized if the patient needs a breast lift or mastopexy, if I need to lower the breast fold, or if the patient requests it. I do not use it routinely, and have difficulties in the patient with small areola. I have found there may be more incisional discomfort with this, though it is the second line incision for breast augmentation and if performed correctly, I have seen no increased risk of capsualr contracture. 

The risk of capsular contracture and infection is higher with the periareolar incision generally speaking. However, I have used the periareolar placement frequently with no resulting infection or CC. Complication rates vary by surgeon, therefore it's probably better to ask the surgeon you're interested in having perform your surgery for their stats.

Infection in breast augmentation is very rare when performed to todays standard of care.  Of the two approached, I prefer periareolar as the inframammary if low can show under a bikini and if high is plainly visible in the nude when standing.  It is my preference to never place a scar on the breast when elevating the nipple is noot necessary which is why I prefer to perform transaxillary cold-subfascial augmentation.  The patient is lifet with a very thin scar in the armpit that usually disappears into a fold in the armpit.

 

All the best,

 

Rian A. Maercks M.D.