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Periareolar breast enlargement


   Of the surgeons performing submammary breast enlargements only a few perform the procedure also through the periareolar approach. The approach is called periareolar, if the incision is made in a semicircular line at the edge of the areola, and the preparation goes directly under the skin avoiding the glandular tissue, after this the implant can be placed under the gland or under the muscle. From this approach, it is not possible to place implants under the fascia of the muscle. We explicitly refuse to use the method and do not consider it as a periareolar approach, when the nipple and areola are simply cut in half crossways, meaning that the ducts of the gland and the glandular tissue are also cut in half in a savage way and the implant is placed under the gland. Only one person does this in Hungary, who didn’t obtain any specialist qualification of our country, but has learnt it in Brasil where it should be used in some places, and tries to justify it careless of the consequences like nipple insensibility, breast feeding problems, cysts, etc.
 
 

Scar of a breast augmentation by cutting the nipple, ducts and glandular tissue in half, operation performed by ANOTHER SURGEON – we do not perform it this way



Schematic view of a submuscular breast augmentation through the periareolar approach



ADVANTAGES OF THE REAL PERIAREOLAR (at the edge of the areola) APPROACH:

On patients having a normal wound healing process with ideal scaring, the scar of the periareolar incision is less remarkable, than the scar of the submammary approach (it is though more visible, than the axillary incision).

If there is a simultaneous small sagging, from the incision of a periareolar mastopexy implants can be inserted as well (unless the diameter of the areola is too small), but this way the implants touch the glandular tissue contaminated with bacteria, which means a higher risk, than placing them from a separate incision through the armpit (transaxillary).



Ideally thin, but light-coloured scar of periareolar breast augmentation – can be corrected with tattooing


DISADVANTAGES OF THE PERIAREOLAR APPROACH:

Visibility and eye control are more difficult and restricted even using a special “cold light source” fiber optics system, which means a higher risk for a postoperative bleeding and therefore also for a capsular contracture, especially in cases of submuscular implant placement. Compared to the visibility by the camera of the endoscope at axillary approach, the visibility for a periareolar augmentation is much more restricted, moreover the camera provides a great magnification.

If the scaring tendency is even slightly abnormal, a scar which is more disadvantageous than the submammary one can be expected (different in colour, perhaps bumpy and wide), which can be hardly corrected (or it is impossible).

The tunnel where the implant is inserted is in touch with the bacteria of the glandular tissue, therefore the possibility of an infection is higher.

The separation of the glandular tissue and the skin downwards results in a prolonged swelling (oedema) in the postoperative period.



Slightly hypertrophic (abnormal) scaring after periareolar breast enlargement


When is the periareolar approach the worst?

If the patient has an abnormal scaring tendency, and/or the measure of the simultaneous sagging is not small, but significant.

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