What is periareolar breast augmentation technique?
Periareolar breast augmentation risks
In my mind, the literature does suggest a slightly higher incidence of capsular contracture when implants are placed through the PA approach.
In addition, there is potentially a higher risk for change in nipple sensation.
And, the scar is on the most projecting portion of the breast and so it potentially has a higher risk for being more noticeable.
That being said, many surgeons achieve great results through all three approaches and so it really comes down to a decision of which incision and which surgeon you feel most comfortable with.
The one incision I would be wary of is the TUBA (belly button approach) which is most commonly promoted by non-plastic surgeons and which has a much higher risk for complications. (Gregory A. Buford, MD, FACS, )
Periaerolar Incision Risks
In theory, the periareolar breast augmentation incision for attaining exposure in breast augmentation has the following increases in risks:
- capsular contracture,
- decreased or loss nipple/areolar sensitivity,
- decrease or inability to breast feed.
In vivo experience the capsular contracture rates are essentially the same. I have seen 30% decreased in sensation and a 10-% to 20% breast feeding problems. (Darryl J. Blinski, MD, Miami Plastic Surgeon)
Periareolar breast augmentation often a good choice
It sounds like you are aware of the theoretical risk of the periareolar incision, which is in closer proximity to breast tissue leading to possible bacterial contamination and capsular contracture. There isn’t much evidence to support that in my view. Another misconception is that it increases the chance of sensory loss to the nipple, also unproven. The inframammary incision works well but if the implant size is ever changed it may no longer be in the fold at the right level. There are plusses and minuses to each option, depending upon implant size and type and other considerations. (Richard Baxter, MD, Seattle Plastic Surgeon)
Breast augmentation incision location
No one really knows what causes capsular contracture but there is likely a combination of causes with some being more dominant is some patients. Factors believed to cause capsular contracture include low grade infections, repeat breast surgeries, genetic factors, blood in the implant pocket, rough handling during surgery causing muscle spasm etc., implant rupture, trauma to the chest, radiation etc. Those are mostly independent of the skin incision used.
Revision rates are something else and can be necessary because of capsular contracture (usually sometime after surgery) or a suboptimal result (usually apparent early after surgery). The revision rate is likely higher the further away from the breast the skin incision is especially in the hands of a less experienced surgeon. Some patients need surgical adjustments to the breast itself at the time of augmentation in order to achieve the best result. And this can be hard or impossible to do if the skin incision is in the belly button or the armpit. The choice of skin incision for implant introduction should be dependent on what the patient needs / wants and the surgeon’s experience.
I personally prefer areolar skin incision over inframammary fold incisions in first time patients because of the tendency of incisions in the fold to migrate. However people scar differently and a bad scar in the areola is more visible than one in the fold. (Aaron Stone, MD, Los Angeles Plastic Surgeon)
Periareolar breast augmentation is safe
Periareolar incision incision has the same safety profile in my experience. Incision size is limited by the areolar size which can be an issue, especially with silicone implants. Which position will produce less noticable scarring depends how visible the inframammary fold region is and what kind of scarring results (Daryl K. Hoffman, MD, Orlando Plastic Surgeon)
In my practice the periareolar breast augmentation incision almost always results in a minimal scar and very low capsular contraction rate.
I don’t believe there is a difference in capsular contraction rates between peri areolar and inframamary incision in breast augmentation and the scar is far better in the peri areolar incision. There are many other techniques which will change the capsular contraction rate. These include preoperative antibiotics, careful tissue handling techniques, changing gloves before putting the implant in the pocket, irrigation of the pocket to remove loose tissue and blood, instillation of the pocket with a triple antibiotic solution and the use of a funnel to insert the implant so that it has minimal contact with the skin and breast tissue.
I don’t electively use the inframamary incision because It is always there and frequently it is a significant scar. With the peri areolar incision my revision rates are extremely low and I would recommend this approach to you. (Carl W. “Rick” Lentz III, MD, Louisville Plastic Surgeon)
Periareolar Incision Risks No Greater than Inframammary
I do not feel that there is an increased risk in either capsular contracture nor infection with a periareolar approach to augmentation. I use both incisions and have never had an infected implant although that is always a risk with either incision. My scar reviision rate is greater with inframammary scars than with periareolar scars. (John Whitt, MD (retired), Toronto Plastic Surgeon)
Periareolar incision risks
The risk of capsular contracture and infection is higher with the periareolar incision generally speaking. However, I have used the periareolar placement frequently with no resulting infection or CC. Complication rates vary by surgeon, therefore it’s probably better to ask the surgeon you’re interested in having perform your surgery for their stats. (Jerome Edelstein, MD, Westchester Plastic Surgeon)
Risks of periareolar approach for breast augmentation
Any increased risks for infection, whether theoretical or real are very minimal.There are many other factors to consider beyond just the scar placement to review with your surgeon when making this decision.
This discussion is too long for this box, but a thorough discussion should be had with your surgeon regarding your particular case. (Neal Goldberg, MD, Manhattan Plastic Surgeon)
Incisions and infection or capsule
I do no think it make a difference what incision is used for surgery in terms of increasing the risk of an infection or capsular contracture. (Steven Wallach, MD, )