Periareolar incision with large (650ccs+) implant?

Dear AnRi12456,

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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Dr. Alavi in San Diego is not a plastic surgeon. He completed Ear-Nose-Throat residency training followed by non-accredited cosmetic surgery fellowship (these are not recognized by any formal governing bodies of graduate medical education). You need to find an American Board of Plastic Surgery certified surgeon that has actually completed 6 years of integrated plastic surgery residency training at the bare minimum.

Thanks for your question! My preference is an inframammary incision (specifically with that size of an implant). That being said, every surgeon has a reason for choosing what he/she chooses, so if you've chosen them and accept that approach, that is your answer. If not, seek a second opinion. Good luck!

The choice of incision placement, even with larger implants, depends on the experience and preference of the surgeon. However, a smaller areola and larger implant can make the peri-areolar technique more difficult.

I guess it largely comes down to experience of the surgeon. I do not think I want to try this! Good luck.

The Areola is a great final scar and if you have a small areola it may make the procedure harder. The Motiva Ergo is a bit harder to insert due to the gel and texture and a Funnel device really helps. Your doctor should be able to answer this question easily, good luck!

There are a number of breast augmentation access incisions. Each has advantages and disadvantages unique to them. The most common are infra-mammary fold (beneath the breast), infra-areolar (beneath the areola),trans- axillary (armpit), trans-umbilical (belly-button).
Generally, the infra-mammary and infra-areolar are the most commonly used as they provide a more direct approach with good visualization. Incisions will generally be 5-6 cm (smaller for saline as they are filled after placement). Limitations on these approaches are generally defined by anatomy. A small areola may not accommodate an adequate incision for access. A patient with a poorly defined fold may not be a good candidate for an IMF incision due to the uncertainty surrounding placement.
Distant approaches such as the trans-axillary or trans-umbilical approach are less direct and have slightly higher complication rates likely secondary to more limited visualization. There are also limitations on the devices used as silicone devices cannot be placed via the trans-umbilical approach. Larger silicone implants are also difficult to place via the trans-axillary approach due to the narrow window of placement through the axilla.
Sensation and the ability to breastfeed are generally unaffected by choice of access incision (although anecdotally, some patients will report greater sensory disruption via the infra-areolar approach).
All are generally reasonable options. Your board certified plastic surgeon is uniquely qualified to guide you to a safe and reasonable surgical plan.

Your doc is living in the past with his preference with periareolar incisions. There won't be less scaring, but instead more. And worse, there will be scaring from skin to implant directly through the breast tissue. This increases your risk of capsular contracture, although not as much with Motiva, but it also increases your risk of other scar related deformities including thinning of tissues where they should be thickest, and the potential for scar tethering of the areola.

There are pros and cons to each incision option. Generally I prefer the inframammary incision as it allows direct access and allows visualization of the pocket. However each person is different and should be evaluated based on anatomy and patient goals. I encourage you to visit a few board certified plastic surgeons near you for a consultation to listen to varying opinions.

You did not post photos, but for most women, 650-700 cc's is much too large and heavy. For that size implant, a peri-areolar incision will be safer in the long run. The weight of such a heavy implant will stretch and thin your lower breast tissue. Over time, there is a risk of the large implant becoming exposed and falling out of an inframammary incision.