How is the periareolar incision made?
The periareolar incision is made on the bottom edge of the areola, where the darker patch around your nipple meets the lighter part of the breast. After the incision is made, your surgeon will create a pocket placement—either over the muscle, just behind the breast tissue; or under the pectoral muscle. Your implants are then inserted through the incision made through the areola, placed in the pocket, then centered, before suturing the breast tissue and skin shut.
Why women choose periareolar breast augmentation
The biggest concerns among women seeking to have a breast augmentation are scarring and aesthetics. Periareolar breast augmentation can give women great results with scars that blend into the areola, the dark patch around the nipple.
Here's more about why women like it:
- Hidden breast augmentation scars. Breast augmentation scars come with the procedure, and there is no getting around it. But because the cut is made where the darker skin of the nipple meets the rest of the breast, the areola incision scar will be minimal and harder to detect once the incision has healed and the scar has been given time to fade.
- More placement options. The periareolar incision allows breast implants to be placed in all placement options, including over the muscle and under the muscle.
- Better control. Because the incision is so close to the breast itself, it allows plastic surgeons to more accurately place and position the breast implant. This could give your breasts an enhanced shape, particularly if you have breast asymmetry or a breast deformity like tubular breasts.
- Your search for a surgeon will be easier. Since the periareolar incision is so common, most breast implant surgeons specialize in this type of breast augmentation as opposed to transaxillary and transumbilical, which are more complex and technique-driven. This means you'll have no problem finding a surgeon who can do this incision, the only thing you'll have to do is make sure he's qualified and does excellent work.
- Versatility. If you want a breast lift with augmentation, or if you decide to go up in implant size later or have a revision surgery in the event of a complication, the periareolar incision means these procedures can be performed through the same incision.
Why women choose inframammary instead
The periareolar incision has a competitor, the inframammary incision. It's also the most common incision site and has the same benefits, but their limitations are different. This is where the periareolar breast augmentation falls short and the inframammary fold comes out on top:
- You have small areola. If the diameter of your areola is too small (less than 3 cm), it can limit certain breast implant sizes, shapes, and fill types. In this case, you'd have to settle for a saline implant that can be filled once it's inserted into the pocket or select a smaller silicone-gel implant. The inframammary incision allows for saline and silicone breast implants of various sizes, shapes, and profiles in women with small areolas.
- You have a connective tissue disorder. If you are one who develops thick, raised scars after an injury, the periareolar incision would likely cause thickening and widening of your breast augmentation scars, which means scarring will be more visible and potentially unsightly. With the inframammary incision, the scar can be hidden in the crease of the breast and covered by a bikini or bra. If you have a connective tissue disorder tell your surgeon so he can assess your individual risk for breast augmentation scars.
- You plan to breastfeed or want full nipple sensation. Because the periareolar incision cuts close to milk ducts and cuts through breast nerves close to the nipples, you could lose nipple sensation and have difficulty breastfeeding. These complications are mitigated with the inframammary fold incision as it bypasses the milk ducts and nerves connected to the nipples.
- Higher risk of capsular contracture. The milk ducts harbor gut bacteria that are beneficial to your baby, but not your breast implants. During the periareolar incision, if the milk ducts are severed, bacteria can get around the breast implant, causing an infection that could contribute to breast capsule thickening or capsular contracture. You could end up with a firmer, distorted-looking breast. Since the inframammary fold incision does not affect the milk ducts, bacteria transfer specifically from milk duct leaks is obsolete.
Which is better, inframammary or periareolar breast augmentation?
The quick answer is that the choice comes down to your areola size, breast tissue density, skin elasticity, and overall preference. Consulting with a board-certified plastic surgeon and having an examination will help you better understand which incision type is best for your individual case.
But for some women, it comes down to scarring.
Periareolar scars may go through a period of thickening and scar tissue formation for two months, then begin to fade over the course of several more months. The fading process depends on your body, often taking longer if you have a connective tissue disorder or healing disorder. That said, it may take anywhere from four months to two years for scars to become softer, flatter, and closer to the color of the surrounding skin.
The incision and scar healing period for the inframammary incision may be longer because the incision is longer, but at least with this incision type, the scars are hidden in the crease during the recovery and fading period.
Have questions about periareolar breast augmentation?
Drop your inquiries in our "Ask a Surgeon" Q&A forum. Board-certified plastic surgeons from around the country want to answer them. Or, if you'd rather hear from women who've had the periareolar incision, hop into our breast augmentation forum.
Borgognone A, Gherardini G, Gliosci L, D'Andria D. (2017). Is periareolar incision a suitable option for breast surgery? A mathematical comparison between periareolar and inframammary fold approaches. Open Access Surgery. Retrieved from https://www.researchgate.net/publication/313683499_Is_periareolar_incision_a_suitable_option_for_breast_surgery_A_mathematical_comparison_between_periareolar_and_inframammary_fold_approaches
Gould SE. (2013). The bacteria in breast milk. Scientific American. Retrieved from https://blogs.scientificamerican.com/lab-rat/the-bacteria-in-breast-milk/
Carvajal J, Echeverry A. (2005). Alternative Technique for Breast Augmentation in Patients with a Small Nipple-Areolar Complex Diameter. Aesthetic Surgery Journal. 25:117-125