Does areola incision have more risk for capsular contracture or any other complications than under the fold incision?

A breast augmentation (insertion
of implants) is most often performed through one of two different small
incisions. These include 1) an incision around the lower half of the nipple
areola (peri-areolar) or 2) an incision in the breast crease between the breast
and the chest wall (IMF - infra-mammary incision). The choice of incision is influenced by multiple factors including
surgeon preference, patient preference, patient anatomy, and / or type of
implant.



Periareolar incisions are fraught
with challenges, however.

1) Accurate dissection of the
implant pocket and positioning of the IMF can be more challenging

2) The scar at the skin/areola
junction is usually obvious and almost always widens due the force of the
implant - especially in larger augmentations

3) There is an increased rate of
contamination of the implant from the nipple leading to infection and an increased rate of capsular
contracture



IMF incisions in contrast have
none of these issues.

1) The incision allows the most
direct access to the surgical site allowing ultimate control over the size and
shape to the pocket and the position and integrity of the IMF

2) The scars usually heal to a
thin line in the natural breast crease without concern for widening or
visibility in most circumstances

3) The IMF incision avoids
contamination from the nipple



A detailed examination will help
delineate the best surgical option. Consultation with a surgeon certified by
the American Board of Plastic Surgery would be the next best step.

That's
a good question. I think you'll find differing opinions among the specialists
who respond, partly because the research into this issue continues to evolve.
There are some studies that suggest making the incision at the areola is linked
to higher rates of capsular contracture, but they aren't conclusive. One of the
techniques I use to lower the risk of complications such as capsular
contracture is using the KELLER FUNNEL™ 2 to insert breast implants. This is a
"no-touch" technique that significantly reduces the risk of bacterial
contamination during the procedure (which is thought to be a potential cause of
capsular contracture). Inframammary fold incisions are the most common choice
in the U.S., and they aren't linked to an increased risk of capsular
contracture, so they might be the best for peace of mind.

There is some evidence that an areola incision leads to a higher incidence of capsular contracture. If this is something that worries you, I would suggest an under the fold incision. My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram