Areolar Incision

Overview

Women who are self-conscious about their breasts' appearance may find that breast augmentation can help them achieve their goals of shapelier, fuller breasts. Breast augmentation can help women feel more confident by improving the appearance of their breasts. Breast augmentation can help women who are self-conscious about their bust line regain confidence and pride in their bodies.

Depending on the type of breast implant used and the incision technique used, each breast augmentation procedure will be unique. The areolar incision is one of the most commonly used incisions. 

What is Areolar Incision?

The areolar incision, also known as the periareolar incision, is one of the most commonly used breast augmentation incisions, allowing surgeons to place breast implants through an incision made around the areola, the dark, circular tissue surrounding the nipple. The areolar incision technique involves making an incision around the areola where the darker tissue meets the rest of the breast.

Although the technique is commonly referred to as the nipple incision, it does not directly affect the nipple but rather encircles the areola. The darker pigmented skin that surrounds the nipple is known as the areola. The areolar incision is made just outside the pigmented skin.

Once the incision is made, the implant can be inserted above or below the chest muscle. Because the incision is located where the tissue color changes between the areola and the breast, placing it around the areola reduces the appearance of scarring.

The infra-areolar incision is also known as the peri-areolar incision. This is also referred to as "going through the nipple" by some. This is due to the fact that the incision is made just outside the border of the areola, the darker skin that surrounds the nipple. If a fine white scar forms, it will be less visible against the lighter skin than if it formed within the areola itself.

Periareolar incisions are made at the areola's outer edge, following the curve that separates the darker skin of your nipple from the rest of your breast. After making an incision on the lower semicircle of the areola, a pocket is created (either inside the breast or beneath the muscle), and the implant is slid in through the incision, moved into the pocket, and centered.

What is Areola?

The pigmented area on the breast around the nipple is known as the human areola. Areola is a small circular area on the body with a different histology than the surrounding tissue, or other small circular areas such as an inflamed region of skin.

Several small openings are arranged radially around the tip of the lactiferous ducts, from which milk is released during lactation, in the mature human female nipple. Sebaceous glands, also known as areolar glands, have small openings in the areola.

The Benefits of an Areolar Incision

Benefits of the areolar incision include:

• Greater surgical control: The areolar incision allows for more precise implant placement during surgery.
• Scarring from an areolar breast augmentation incision is less visible than scarring from other approaches because the incision is made where the areola meets the breast.
• Breast implants can be placed in any plane: Breast implants can be placed in any plane using the areolar incision, which means they can be placed fully under the muscle, partially under the muscle, or over the muscle.
• Many breast augmentation complications, such as capsular contracture and hematoma, can be corrected using this incision, so patients are unlikely to require a second incision site if a complication occurs.

Is periareolar incision a suitable option for breast implant?

Breast implant surgery is one of the most common procedures performed by plastic surgeons in the United States. In 2014, 284,254 augmentation mammoplasties and 8,455 reconstructive breast procedures were performed with an implant alone, as well as 74,694 with a tissue expander and implant.

The recommended incision site for the insertion of the implants, as well as its length, have been hotly debated since the introduction of the last generation of shaped, silicone cohesive gel implants.

Furthermore, it is worth noting that the preoperative breast tissue and the volume of the implant chosen as critical factors, in addition to the previous list, can have a significant influence on the location of the more convenient skin incision.

The inframammary fold (IMF) incision is the most commonly used for breast augmentation; it has been shortened to as little as 1.7 cm in order to insert smooth, round inflatable implants, but even this size leaves visible scars, prompting the development of more precise methods; on the other hand, some authors maintain that the incision site is unimportant.

To better define the issue, it is widely agreed that an appropriate incision length, regardless of location, is required to avoid damaging the architecture of the prosthesis's silicone core. A new modification of the nipple-areola complex (NAC) incision has recently been introduced to try to take advantage of the diameter of small areolae as much as possible.

This confirms the benefits and flexibility of the NAC site, even in the more restricted area of the base of the nipple, where a proper pocket can be performed and the more appropriate mammary implant inserted.

Once no significant differences between women undergoing inframammary and periareolar mammaplasty approaches have been determined, the incision length afforded by a curvilinear section and the selection of the most appropriate approach for inserting the anatomical form – stable implants – should be considered. This is the first report of a mathematical comparison of linear IMF and periareolar access incisions that we are aware of.

The periareolar approach has a 36% advantage over inframammary access and may be especially beneficial for small areolae. To summarize, the evidence presented here may have positive implications in a subset of patients, and we believe that these findings will be useful in future clinical trials.

The Disadvantages of the Areolar Incision

When considering an areolar incision, there are some risks to be aware of, just as there are with any type of breast augmentation. Consider the following when deciding whether an areolar incision is the best approach for your breast augmentation:

• Increased risk of infection: Bacteria naturally inhabit the milk ducts, and because an areolar incision necessitates the passage of the implant through the ducts, these incisions are slightly more vulnerable to bacterial infection.
• Loss of nipple sensation: Patients who have areolar incisions are at risk of losing nipple sensation.

Areolar Incision Technique

Making an incision along the lower edge of the areola, or the dark circle of skin that surrounds the nipple, is the areolar breast augmentation incision technique. One advantage of making the incision here is that the scar from the surgery usually blends in with the edge of the areola. Except when examined closely, the scar is barely discernible.

However, some patients prefer the transaxillary, or underarm, incision technique because it leaves no visible scarring on the breast. However, because of its proximity to the breast, the areolar incision allows for greater control over the placement of the breast implant.

The areolar incision technique is ideal for patients who want to have breast augmentation and breast lift surgery at the same time.

However, not all patients will be good candidates for areolar incision breast augmentation. Patients who want larger silicone-gel-filled breast implants, for example, may not be good candidates for this incision technique. Patients should also be fully aware of the risks associated with the procedure, such as the possibility of scar thickening, which could cause visible puffiness at the lower borders of the areolae.

A half-circle incision is made at the bottom edge of the areola surrounding your nipple during this surgery. Your cosmetic surgeon will cut through fat and breast tissue beneath your nipple to create a pocket in the breast above or below the pectoralis major muscle. Your doctor will then insert and position your silicone or saline implant in this pocket.

If you chose saline implants, they will be filled next. Your surgeon will then use dissolvable sutures to close the areolar incisions and dress the incision area. Surgical tape can be used to keep your incision closed while the wound heals, which reduces scarring. 

Periareolar surgical technique in breast tumors

The procedure was carried out while the patient was supine and under general anesthesia. The mass's surface projection on the skin was marked, and the distance from the mass to the areola was measured. The periareolar incision area closest to the mass was chosen.

If there were multiple masses, the incision was chosen based on the location of the majority of the masses, or the incision on the upper outer edge of the areola was chosen to ensure normal nipple and areola sensation. The length of the incision was determined by the size of the tumor and the distance from the tumor to the areola, and it was no longer than half the length of the areola's perimeter.

The skin, subcutaneous tissue, and superficial fascia were all incised sequentially until the gland surface was reached. The incision was opened, and the tissues between the subcutaneous adipose tissue and the mammary gland capsule were sharply separated until they reached the mass's surface. If the mass was too far away from the areola, it was pushed or pulled towards the incision with forceps.

The gland layer was radially incised, and the mass, along with a portion of the surrounding normal glands and adipose tissue, was completely removed. To stop any bleeding, electrocoagulation was used. The surgical residual cavity was not sutured, nor was a drainage tube inserted.

Sutures were used to close the subcutaneous adipose layer, which was then followed by intradermal sutures. Medical biological glue was used to cover the incision. Bandages were used to compress the resection site after surgery.

Mammary gland lobectomy, segment and quadrant resection could be performed on patients with multiple and relatively concentrated masses. The gland layer was radially incised along the direction of the mammary ducts until the retromammary cellular space was reached during the procedure. Using their fingers, the surgeon thoroughly explored the gland layer. The glands, as well as all of the masses, were pulled beneath the incision. Multiple masses, as well as a portion of the surrounding normal mammary glands, were surgically removed.

For patients who underwent subcutaneous mastectomy, a portion of the normal mammary glands were preserved beneath the nipple and areola to ensure the nipple-areolar complex's blood supply. To avoid post-operative nipple collapse, the nipple-areola plasty was routinely performed.

For patients with a thin subcutaneous fatty layer and more gland tissues, the breast collapsed significantly after surgery. Silastic gel breast prosthesis implantation could be performed surgically for these patients based on their needs.

Recovery after Breast Augmentation

As with any surgery, patients will need some recovery time, usually about a week, before returning to work or other normal activities. Although many patients feel well enough to resume normal activities within a week of surgery, a full recovery will take about six weeks, so patients should avoid overexertion while they heal.

Patients should expect some pain, swelling, and bruising during the initial recovery period. As the body adjusts to the newly placed breast implants, the breast tissue and chest muscles may also feel tender and uncomfortable. As the body heals, pain medication and ice packs can help to relieve pain and reduce swelling.

Breast Surgery

In addition to breast augmentation, there are three other types of breast surgeries.

• Reduction mammoplasty, also known as breast reduction, is a surgical procedure that removes excess tissue and repositions the nipple and breast crease in order to reduce the size of large breasts.
• Mastopexy, also known as a breast lift, is a surgical procedure used to correct sagging breasts. Surgeons remove and rejoin skin tissue to reposition the breasts. The tighter skin provides more support for the breast's weight. This procedure can be combined with an augmentation or reduction.
• Plastic surgeons use breast reconstruction to rebuild breasts that have been removed or damaged. New breasts can be built over implants by reusing tissue from other parts of the body and stretching abdominal tissue. There are numerous techniques involved in restoring a natural appearance: The nipple can be removed from the old breast and attached to the new breast in some mastectomy cases; another method involves a special type of tattooing that creates the appearance of a nipple on a reconstructed breast.

Conclusion 

Breast augmentation, also known as augmentation mammaplasty, is a cosmetic procedure that uses implants to increase the size of a woman's breasts through one of several incision techniques, including inframammary and areolar breast augmentation.  

A periareolar incision gives female patients with benign breast disease hope; it allows the disease to be cured while keeping the breast's appearance. Because of the quick recovery, hidden incision, small scar, and other benefits, the periareolar incision should be used as the primary surgical technique for benign breast disease. However, periareolar incision necessitates more technical skill from the surgeon and may result in areola collapse.

As appealing as this all sounds, there are a few drawbacks to the periareolar incision method. For one thing, if the scar does not heal well after breast augmentation, which can happen, it may be much more visible (raised or lighter in color than the areola) than you would like.

This type of incision is also more likely than any other to sever milk ducts and nerves in the nipple, which can lead to difficulty breastfeeding or loss of sensation in that area, and some studies have suggested that it poses a higher risk of capsular contraction than the other incision types.

In terms of breast appearance, we recommend that patients with high cosmetic expectations have silastic gel breast prosthesis implantations to maintain a good breast shape.