Without an exam, I am not sure if you can have this surgery done through the areolas. The 410's need a large incision than the saline and the memory gels.
Implant, Incision, and Infection when performing breast augmentation
As stated, there are a few issues here:
- Size of implant'
- Size of areola
In addition, placement through the areola and glandular tissue has been associated with a higher risk of bacteria transmission to the implant. In theory this produces a higher risk of biofilm formation which has been associated with a greater potential to develop capsular contracture
Through the nipple breast augmentation with Allergan 410
Through the nipple breast augmentation is very popular in our practice with both the saline, and the silicone gel breast implants. The scar is hidden in the color break in the skin and the augmentation looks very well. The diameter of the nipple must be large enough to accommodate the implant; no problems with the saline, with a gel implant the nipple may need to be 4 cm, a fairly average size. There is no published data which shows a higher capsule contracture rate for periareolar implants, nor one that shows a higher infection rate. We have no infection after breast augmentation, though do see capsules form for a very few.
We use many Allergan 410 implants, however in the US they are not approved for breast augmentation, only for breast reconstruction so if they are offered to you this may be a red flag. The Allergan 410 is a 'form stable' implant which is less compressible than a regular gel. The incision required to place the implant is larger than the diameter of most areolas, so infra-mammary incisions are the norm. If the incision is too small and the implant is forced, it is possible to fracture the gel inside, and affect the performance of the implant.
Best of luck.
Peri-areolar Breast Augmentation
The peri-areolar approach is an acceptable approach for BAM. To use it, the patient must have adequate sized areolas, larger for silicone than saline. This approach has a slightly higher risk of infection and contracture, and I am not sure that it will give you a better chance of avoiding a keloid.
Mentor style 410 form stable implants
The Allergan 410 and Mentor CPG implants are form stable textured silicone implants- currently only available from a few surgeons permitted to use them as part of the FDA approval process. I'm not one of them, but I placed a few CPGs when I was a plastic surgery trainee. The implants are less malleable and are texturized. I think it would be difficult, if not impossible to place even a smallish form-stable implant through a peri-areolar incision. Every case I saw used an IMF incision, and it was a generous incision (4-5 cm).
We're all anxiously awaiting the FDA approval of Mentor CPG and Allergan 410 form stable implants for cosmetic use- they will be useful in a subset of patients, and the capsular contracture rate is exceedingly low.
Through the nipple augmentation using Inamed 401 Breast Implants
It depends upon the size of implant and the size of your areolar. The bigger either one is the easier the result, to a degree. As for scars or keloids. If you are a keloid former then it does not matter where the incision is. Regards.
Periareolar breast augmentation does not necessarily mean a better scar
If your skin truly forms keloids, having the scar under your nipple may not make you happier....
Also, periareolar placement may expose your implants to more bacteria, and formation of a "biofilm" that has been implicated in the formation of capsular contracture (when tight scar tissue forms around your implants).
The take home message is that these options MAY or MAY NOT be in your best interests... You should always choose a SURGEON you like and feel you can trust and follow their recommendations.
Choosing the procedure/scar/implant you want and THEN finding a surgeon willing to do what you want is a big mistake.
For more on how to responsibly and safely evaluate surgeons, please read this: