Pros and cons of periareolar incision during breast augmentation

Periareolar incision and Capsular Contracture

Data would suggest that the chances of developing a capsular contracture are slightly higher when utilizing a periareolar incision. In my practice, the peri areolar incision is my preferred approach as it is with my associate. We experience a cc rate that is comparable, if not lower, than the national average.

I believe the periareolar incision provides the added benefit of allowing for NAC asymmetry correction, should it exist. It provides a superior scar, in my opinion, and allows for the best access and visualization of the breast pocket. In Beverly Hills, among my colleagues, it is the preferred approach. (Glenn Vallecillos, MD, Beverly Hills Plastic Surgeon)

Breast Augmentation Incisions – Key Considerations

There are 3 primary incision options for breast augmentation. All are acceptable and depend on the patient’s choice and the surgeon’s experience and expertise:

Periareolar incision after breast augmentation

  1. The most common approach is in the Inframammary Fold – simple, easy access , heals well , and gives the best opportunity for correction of any subtle breast asymmetries. It is the most common incision I use for both saline and silicone implants. In my experience, it has a very small nipple sensory loss incidence.
  2. The Periarealar approach – must be made precisely in the areolar – breast skin interface to prevent the scar from being visible . There is no good data to support that it causes more infection or implant contracture. Therefore, it really comes down to surgeon and patient preference. I use it in patients with almost no breast tissue or no apparent inframammary fold . It is not my preferred approach
  3. The Transaxillary approach – the armpit incision is also a good approach and was popular in the 90’s and is use more in certain regions of the USA than others due to surgeon and patient preference. Again, it has no distinct disadvantages except perhaps it is more difficult to correct primary breast asymmetries using this approach (Rod J. Rohrich, MD, Dallas Plastic Surgeon)

Incision Options for Breast Augmentation

Breast augmentation incision sites areola scar

Although there is a theoretically increased risk of capsular contracture and bacterial infection with a periareolar incision, this does not bare out clinically. Ultimately the ideal study would be to perform one incision on one breast and another incision on the other and compare the results.

However, most patients would not sign up for this type of study for obvious reasons. Also rthere are many factores that contribute to capsular contracture and it would be difficult to say that the incision location was reponsible.

I perform the majority of my augmentations through the periareolar incision because it gives the extra advantage of making any adjustments to the areolas when there are small asymmetries. Periareolar incisions also heal very well because they are paced right at the edge of the darker areolar skin and the native breast skin.

Periareolar incision recovery photos

There is a correlation between nipple sensation changes and periareolar incisions but the influencing factor was implant size, with larger implants leading to greater chance of nipple sensation changes.

Overall, if done properly both incisions are inconspicuous and are not related to a higher or lower chance of complications.  (Babak Dadvand, MD, Los Angeles Plastic Surgeon)

Which is The BEST Incision in Breast Augmentation Surgery?

Periareolar incision photo

It would be a wonderful thing if a properly picked breast implant could be magically beamed / transported into a breast without putting any scar on it or in adjacent tissue. Unfortunately, until that day comes, we need to choose between the positives and negatives associated with each breast incision / scar.

Furthermore, every woman contemplating a Breast Augmentation must accept that these implants will not last a life time; They WILL leak anywhere from the day of surgery up to 25 years or so later and will then need to be replaced. In addition, breast implants may become severely scarred (Capsular Contracture) requiring surgery or become infected (requiring removal).

Periareolar incision breast augmentation recovery after surgery

In other words, the Breast Augmentation is NOT the final operation but you may require several breast operations afterwwards. In choosing THE BEST Breast Augmentation incision, you are advised to choose THE incision with the most positives and least negative attributes. The periareolar approach (scar) is unmatched by any of the other approaches in many ways; it offers unmatched visibility in implant pocket dissection and, if needed, repair or reviion (better than ALL other incisions).

Unlike all incisions, the periareolar scar offers the best accuracy in pocket creation. Unlike other scars, it can BOTH be used REPEATEDLY in ALL forms of revision as well as to lift the breasts when they start sagging. The only THEORETICAL negatives are a potentially higher rate of nipple sensory loss and of capsular contraction. Despite having a large experience with breast augmentations, I have NOT found this to be true in practice.

When I present my patients with the full picture, the overwhelming majority choose a periareolar approach Breast Augmentation. (Peter A. Aldea, MD, Memphis Plastic Surgeon)