Is it possible to do a Periareolar augmentation on small, size A breasts? (photo)

Is it possible to do a Periareolar augmentation on small, size A breasts? I currently am a size 32 A and will be going with a 371 moderate plus silicone implant. Is it possible to do a Periareolar augmentation, under muscle? Will I be able to nurse within the next 10 years? What is the benefit versus through the armpit or through the inframammory fold? Thank you!

Doctor Answers 14

Is it possible to do a Periareolar augmentation on small, size A breasts?

You are a good candidate for any of the three incisions you mention. A Peri Areolar approach is the most likely to disrupt milk ducts. Please consult with a board certified plastic surgeon.

Toronto Plastic Surgeon
4.9 out of 5 stars 469 reviews

Incision choices in breast augmentation

Any of those three incisions can work. I think that each surgeon is most comfortable with one or two incisions. Choose your surgeon not based on the incision they use, but on their results and board-certification by the American Board of Plastic Surgery. 

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

Incision for breast implants

Any of the three incision sites are acceptable options.  Different surgeons have different preferences for incisions in breast augmentation.  Personally, I prefer the infra mammary incision. It heals beautifully, provides simple access and makes revision easier if needed. Auxiliary incisions are difficult to perform revisions through.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Can I Have Peri-Areolar Breast Augmentation to 371 gel on Small 32 A Breasts?

I don't think so. Although one can use a Keller Funnel to get smooth gel implants through relatively small incisions,  the size of the areola shown looks like 3.0 cm or less.  That would not allow sufficient incision length to insert the implants. It could be done with saline implants, but that is not what is desired in this case. Even when the areolae are larger, if the incision has to go too far around the areola and then through breast tissue there is an increased risk of nipple numbness. That alone can interfere with breast feeding because it blocks the milk let-down reflex.   
In the case shown, I would recommend the infra-mammary approach for its predictability, and low re-operation rate.  Underarm approaches have a higher incidence of implant malposition than infra-mammary. 
 Another factor to consider, even when a peri-areola augmentation is possible, is that the dissection is through breast glandular tissue which is not sterile and which has bacteria that have been implicated in causing capsular contracture. Capsular contracture rates are higher after periareolar breast augmentation.

Robert M. Lowen, MD
Mountain View Plastic Surgeon
5.0 out of 5 stars 50 reviews

Possible periareolar augmentation

It is difficult to say without knowing the dimension of you areoalr whether an implant of that size would be able to be approached from that incision. There likely will be some breast tissue cut during that procedure so you might be able to breast feed but not all the ducts may be able to empty their milk as some might be cut. I believe the inframmary incision has some benefits as to a lower capsular contracture rate though.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews


You could have a periareolar augmentation with a Keller funnel. It it possible that the periarolar approach might disrupt breast ducts and decrease milk production in the future, although this has not been proven. There has been less contracture and implant rupture through the infra mammary subpectoral approach. With the newer silicone implants being stronger, the axillary and umbilical approaches have gone out if favor, as a larger incision is required. 

Wesley G. Schooler, MD
Santa Barbara Plastic Surgeon
4.8 out of 5 stars 17 reviews

Best incision for breast augmentation

Best incision for breast augmentation
You are probably and candidate for any of these or even a saline implant through the belly button.
What are your greatest concerns?
How do you feel about location of incisions and scars?

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Is it possible to do a Periareolar augmentation on small, size A breasts?

The periareolar subpectoral augment is the most common approach in our office. I personally quit doing the axillary approach when articles started coming out indicating a higher infection rate.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Periareolar vs axillary

It is likely that you could have your surgery done with a Periareolar incision. If your areola is too small for the implant you choose, then a surgeon would have to use another incision. An experienced surgeon will be able to tell. 

In my practice you would have an axillary incision with an endoscopic placement of silicone implants. 

The periareolar approach usually causes some loss of sensation. Cutting through the breast may affect your ability to breast feed. As your skin is darker, the scar will likely be lighter in this area and more obvious. The scar will be in the center of your breast and visible every time you look in the mirror. Some areolar scars heal well but given your photo, in my experience, in your situation these scars can be somewhat visible.  In contrast, most axillary scars are very minimal and in some cases invisible. 

I've never had an implant infection with an axillary approach. But I have had infections when the implant was placed through the areolar which is one of the many reasons I no longer use a periareolar incision. The breast is not a sterile organ and the highest concentration of bacteria is in the fluid in the ducts of the breast beneath the areola and in the nipple. Bacteria on an implant is also known to cause capsular contracture.  Most surgeons agree that minimizing bacterial exposure can reduce the risk of contracture.  I believe the best way to do this is to avoid a periareolar approach, along with minimizing any handling of the implant.  Our contracture rate seems very low compared to the usual figures of 3 to 5%. 

Best of luck with your surgery. I think you will have a great result!  I would love to do your surgery as you look like an ideal candidate. 

Shim Ching, MD
Honolulu Plastic Surgeon
4.6 out of 5 stars 48 reviews

Periareolar incision

A periareolar incision is my preferred method of placing breast implants. I almost always place them under the muscle. Based on your photos, there would be no problem placing them via a periareolar incision. I use a "Keller Funnel" which makes it even easier to place. In almost all instances, you will be able to breast feed. As far as nipple sensation loss, the number is around 10% and it doesn't matter which approach you use. I do find it more difficult to place larger silicone implants via a transaxillary (armpit) approach. I wish you the best in your search.

Paul E. Chasan, MD
Del Mar Plastic Surgeon
4.9 out of 5 stars 40 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.