Breast augmentation via periareolar incision technique involves making a small U-shaped opening within the border of the nipple-areola complex. It usually results in well-concealed scars, particularly when the wound has been meticulously closed with sutures that minimize tension on the skin.
One of the most common concerns with the technique is the risk of milk duct injury, which plays a crucial role in breastfeeding and sensation. For this reason, many surgeons will always prefer other incision sites such as the inframammary fold and armpit unless there is an indication for breast lift.
Because breast lift always involves incisions around the areola, it becomes an ideal incision site if breast implant surgery is performed simultaneously, thus preventing additional scars.
While the milk ducts are mostly concentrated around the nipple-areola complex, during periareolar breast augmentation not all of them will be transected or injured. On average, there are 13 to 25 breast ducts found in the female breast, thereby increasing the likelihood of successful breastfeeding in the future even after this technique.
Nevertheless, many surgeons prefer to “err on the safe side” by using the inframammary fold, armpit, or even navel incision instead because of the perceived lower risk of nerve injuries and sensation-related problems.
Some doctors also argue that breast augmentation via periareolar incision leads to higher risk of capsular contracture compared to other techniques, making other sites a more viable option.
Capsular contracture, or the formation of copious amount of scar tissue around an implant (not just breast implant but also artificial heart valves and facial implants), is often linked to low-grade bacteria and implant contamination at the time of surgery. It is believed that the nipple-areola complex contains a high number of staph bacteria, predisposing the patients to such risk.
Many surgeons in Los Angeles plastic surgery believe that the risk of milk duct injury is more closely associated with the implant size, suggesting that larger augmentation leads to higher risk of nerve impingement, breastfeeding difficult in the future, longer recovery, and more postop pain and discomfort.
Breast implants that are too large for the underlying anatomy to handle also result in a wide range of short- and long-term complications such as visible rippling, more palpability, bottomed-out appearance, chronic breast pain, and implant displacement.
To further minimize risk of milk duct damage, many surgeons recommend the use of submuscular technique in which the implants are positioned underneath the muscle rather than above this thick layer, leading to less disruption to the anatomies that play a crucial role in breastfeeding.