Areola vs crease incision

[jjv33]

Hi, When I met with my surgeon, he suggested the areola incision. I think he said he would just cut around the bottom, not the whole nipple. Not sure if you need to know this but I am 5'4" 110 lbs currently a B cup with a small frame, very light skin as well as my areola. I am going with 286cc silicone. I went for a 2nd opinion because I was unsure on the size and this doctor suggested the crease incision. Now I am sure on the size and not the incision. What has a less noticible scar? I had rhinoplasty and no scar shows at all. He said since he saw how I healed, he thinks I would heal great around the areola. He thought the crease would be more noticable. I have a small fold.
I know there is more chance for an infection through the areola, but I am more worried about the loss of sensation. I am not having anymore kids but don't think I want to lose feeling there. Does it always happen or do you always get it back fully after a year?
Please let me know the differences and your suggestions. Thanks

[Dr. Mele]

Dear jjv33:

The periareolar incision around the base of the areola (the colored area around the nipple) from 4 to 8 o'clock is my favorite. There is no increased risk to nipple sensation when compared the the crease (inframammary fold or IMF) and both are less likely to reduce sensation than the axillary approach.

If there is a color change between your skin and the areola this helps to disguise the periareolar scar. It is also always hidden in clothing. The main limitation for me is using it with silicone gel implants.

The areola needs to be large enough to allow the implant to be inserted without force. Forcing a silicone gel implant through too small an incision has been shown to increase failure rates and make the implants more likely to leak. In cases where the areola is too small, or the implant is too big, I use the IMF approach to decrease the risk of a future deflation.

I also put the IMF incision just above the crease. This way, if you are wearing a bikini and the bottom of the bikini it creeps up, the scar is not right there to be seen.

Both are great incisions so when either way will work I give my patients the pros and cons and let them decide. Since saline implants are inserted empty I can always place then through a smaller incision and there is not size limitation for the periareolar incision.

There is a more detailed discussion of this on my web site here:

http://www.drmele.com/html/breast-au...ision-location

Hope this helps.