Periareolar Vs Inframammary Fold Incision (En Bloc Capsulectomy & Breast Implant Removal)?

I believe your capsulectomy can be done through your periareolar scar/incision. The periareolar incision allows enough access to the breast to do a complete capsulectomy or partical capsulectomy. Since you are doing a revision, I would suggest a silicone implant placed underneath the muscle. This should statistically decrease the chances of capsulectomy contracture. I don’t think you will require an inframammary incision.

In my practice, I advise patients similarly to your surgeon.  The inframammary incision is very well hidden and has shown to have a beneficial effect on the incidence of capsular contracture- a recent study showed that patients who had their implants placed through an inframammary incision had an 11% lower rate of contracture than those who had their breast implants placed through a peri-areolar incision.

In hundreds of breast implants placed, nearly all through an inframammary incision, I have NEVER had anyone complain about the resulting scar.

 

 Thank you for the question on block breast implant removal refers to a procedure where the breast implant and the surrounding capsule is removed as a single unit.  The procedures is performed such that the  contents within the breast implant capsule do not come into contact with the surrounding tissues.  Generally, the procedure requires a longer incision (6-7 centimeter) usually in the inframammary fold, in my experience.  Also, in my experience, the procedure is more successful when capsules are thickened as opposed to when patients are very thin (normal) capsules.  Also,  sometimes complete capsulectomy is not safely possible;  for example, breast implants place in the sub muscular position may have a capsule that can be  densely adherent to the patient's rib cage. Removal of this posterior capsule can be potentially dangerous.





Generally speaking (in my opinion), unless the breast implant capsules have thickened (and/or are otherwise symptomatic), are associated with the ruptured silicone gel breast implants, or if the patient has concerns about "medical conditions" related to the breast implants, capsulectomy is not universally necessary. For these patients, en block removal of breast implants is a good procedure.





On the contrary (again), capsulectomy can expose patients to additional risks, such as bleeding, size loss, contour irregularities and other serious complications. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). For example, attempting to remove very thin capsule densely adherent to the patient's rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity.



You may find the attached link, dedicated to breast implant removal surgery concerns, helpful to you as you learn more. Best wishes.

I find it safer to do an en bloc capsulectomy through a fold incision. If you and the surgeon felt simple implant removal were satisfactory, that could be done through any incision. All the best.

The choice of incision may depend on the sise of your areola, thickness of breast tissue, and other anatomic features. If you are just removing the saline implants, the old periareolar incision may be possible. However, if you are also removing extensive capsules and trying to minimize surgical trauma, let your surgeon choose the approach that will be easier in your case. 

It sometimes can be difficult to remove the capsule through a periareola approach especially if the incision is very small.