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.

I prefer the crease incision because of direct vision, healing of the scar and less potential contamination from the areaola and direct access the fold beneath the breast. Many times the fold will need to be lowered or moved higher. The areolar incision has been proven a safe approach by using antibiotics and cleansing the skin. Understand all the risks and benefits of the approach.

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

There are studies that say that periareolar incisions have a
higher capsular contracture rate than inframammary incisions.
Many plastic surgeons do not see an increase in capsular contracture rates in
their practice when the periareolar incision is used. Your concerns about the various breast implant
insertion sites should be discussed with you during your evaluation. The plastic surgeon will make suggestions based on your evaluation and concerns. Good results can be obtained from either
insertion site.

Scientific studies show that the periareolar approach has a slightly higher risk of capsular contracture. That is simply want the research shows.And, operating on or around the nipple always carries the theoretic chance of decreasing the sensation of the nipple, making the nipple numb, or making the nipple hypersensitive.As well, depending upon the pigment of your skin and areola, the scar may in fact be more evident than under the fold.Those are the potential downsides to the areaolar incision, though it does have a roll in women or looking to avoid the incision under the breast. Discussed your choices with her plastic surgeon who can give you better advice based upon your specific case and exam. Best of luck!Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Yes, studies seem to show that periareolar incision is associated with a higher rate of capsular contracture. It is also more likely to cause issues with altered nipple sensitivity and potentially interfere more with breastfeeding than an inframammary crease incision. The scars are also generally more visible around the nipple as well. Hope that helps! 

Thanks for your question. There is a slightly higher risk of capsular contracture with this incision. The increased risk is slight and does not stop plastic surgeons from using it. If there are other reasons for the periareolar scar to be used in your case, I would not let the increased risk of CC stop you. 

Thanks for this question.The nipple incision has the advantage of usually forming a very nice scar. It is however thought that there is an increased risk of capsular contracture. In addition, if you get a capsule and you this incision is used for a second time it tends to form a tight scar which is very visible. 

The areolar incision is associated with an increased incidence of altered nipple-areola sensation postoperatively.  Also, since there are bacteria in the ducts deep to the nipple, it is thought that there could be a higher risk of bacterial contamination of the implant, which could lead to an increased incidence of capsular contracture.