In periareolar breast augmentation technique, doctors place a small incision right at the lower border of the areola, which is a ring of pigmented skin surrounding the nipple.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says he prefers the technique due to its well-hidden scar, thanks to the areola’s thin skin that makes it highly resistant to aggressive scarring (keloids). Moreover, placing the scar at the dark-light skin junction means it can blend easily into the background.
To further promote well-concealed scars, Dr. Smiley says it is important to close the wound with multiple rows of sutures without picking up the skin.
“The skin edges must be close enough that they are somewhat kissing. With no or very minimal tension, the skin can heal better as well as the ensuing scar,” says Dr. Smiley in a video he recently posted on Snapchat.
Dr. Smiley says he uses running stitch technique with the use of fine absorbable sutures (almost as thin as a human hair) that dissolve within 3-6 weeks.
One of the most common concerns of patients is the risk of reduced nerve sensation, which could also have an impact on their capacity to breastfeed in the future. However, Dr. Smiley says the risk is very small because the incision “goes down” and so the nerves and milk ducts are spared from significant injury.
“Because we’re not cutting above, which could injure more nerves around the nipple, the risk of reduced nipple sensation is very low, just less than 4 percent,” says Dr. Smiley.
Meanwhile, one major caveat of periareolar breast augmentation is that the incision is placed close to the nipple, which is believed to harbor staph bacteria that are linked to infection and capsular contracture.
To avoid complications, before implantation Dr. Smiley says he always irrigates the implants and breast pockets with strong antibiotic solutions, whereas other surgeons simply use Betadine in an attempt to sterilize the tissue and implants.
“Betadine is too caustic for the internal tissue and implants. At one point, the manufacturer even mentioned that their product should not be used in breast augmentation surgery,” Dr. Smiley says.
“Irrigating with antibiotics remains the best way to prevent or minimize risk of infection and capsular contracture, a complication in which the copious scar tissue forms around the implant, leading to unnatural breast contour and pain,” he adds.
To further minimize the risk of complications, Dr. Smiley uses the Keller Funnel technique in which a disposable cone-shaped device is used to propel the implant into the breast pocket with just one squeeze.