Periaeriolar incision first BA. Ok to do inframammary incision for revision?

First BA was silicone rounds through periaeriolar under the muscle. When it healed, I noticed the scar on nipple attached to the implant/muscle. When I flex my chest muscle, an indentation occurs but moreso around the nipple scar. I do have CC on the same breast. I'm told when I do revision to treat CC, the MD will clean out the scar tissue. If I switch to inframammary incision, would this work? And would the MD be able to clean up the scarring in the nipple area?

Doctor Answers 8

Breast implant incision considerations #plasticsurgery

The infra-mammary breast implant incision has a number of advantages. Recent data demonstrates that the peri-areolar and axillary approaches have a higher rate of capsular contracture compared to infra-mammary approach. That piece of clinical data alone has convinced many surgeons to abandon the peri-areolar incision for breast implant placement.

Inframammary incision preferred

An incision in the inframammary fold (IMF) is the preferred incision for most surgeons for primary breast augmentation as well as for secondary.  Most problems may be addressed with this incision and it hides well.  If an areolar tethering does not improve with deep release, a local peri areolar additional incision for release may be made.  Another option is fat grafting.

Mark D. Wigod, MD
Boise Plastic Surgeon
5.0 out of 5 stars 6 reviews

Breast implant revision incision decisions

There are several things to consider in your case:1. Inframammary incision is best for revisions with capsular contracture.2. Animation deformity may require a specific strategy for correction such as conversion to the split muscle plane. (This can be done through an IMF incision.)3. The scar adherence under the areolar incision is probably best corrected through a separate incision in that location, keeping it isolated from the capsule. A small piece of Strattice in this area can be very helpful. 

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 48 reviews

Inframammary Incisions Best

Hello,For both primary or secondary surgery, the inframammary incision decreases your risk of primary or recurrent capsular contracture, and eliminates the risk of ever getting tethered areolar scaring, a problem that is under-reported but common. Now that you have a tethered areolar scar and capsular contracture, it would not be prudent to treat via an periareolar incision, despite what other online consultants have told you. The data is very clear, and should direct surgeons away from nipple incisions. A total en bloc capsulectomy performed via an inframammary incision will disconnect the tethering scar from below, while excising the skin/scar at the surface of the areola should disconnect the scar from above.  Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Periareolar incision first BA. Ok to do inframammary incision for revision?

Although, it is possible to treat the capsular contracture via an inframammary incision, if you want to also treat the periareolar scar adhesion, the periareolar incision may be the better approach.  Discuss these options with your surgeon.  Once they have examined you, they should be able to give you good advice as to which option would be best for you.  Best wishes, Dr. Lepore.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.9 out of 5 stars 50 reviews

Retracted scars often develop in periareolar approaches

and removing the capsule will not resolve the pulling you get with muscle contraction.  Using a different incisions is completely reasonable but if you want the deformed scar managed and your areola is truly generous so an easy access is achieved, why make a new incision?  But if you are going with shaped textured implants, you can't beat the fold approach for that.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Periaeriolar incision first BA. Ok to do inframammary incision for revision?

Dear ML1985In general, I don't see the need for a new incision unless your surgeon has a very good reason to give you a new one. In cases like this, you need to see more than one consultation and have a good understanding of the issues involved. If you have a scar band extending from your old incision to the pectoralis muscle, you can often see the incision pulled inward as you contract the muscle. In my hands, the best way to resolve this is to remove the scar from the areola to the muscle and then re-approximate breast tissue in a stair-step manner. It is also possible that the rate of cc is lower through a infra-mammary fold incision. Both of these issues and their relative risk in you case are worth discussing with your surgeon.

Afshin Parhiscar, MD
Bay Area Plastic Surgeon
4.9 out of 5 stars 49 reviews

Periaeriolar incision first BA. Ok to do inframammary incision for revision?

I am sorry to hear about the complication you have experienced.  It is very likely that the indentation around the areola is related to the underlying encapsulation. Hopefully, with capsulectomy surgery, this contour concern will improve or disappear.  Although nothing replaces in-person evaluation, it is generally possible to have the operation you are  planning utilizing either the infra areolar or inframammary incisions.  My best suggestion: select your plastic surgeon carefully. Make sure that he/she has significant experience helping patients with this type of revisionary breast surgery. Working together you will come up with the best plan to improve your outcome.  You may find the attached link, dedicated to treatment of capsular contracture helpful to you as you learn more. Best wishes.

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.