Periareolar breast augmentation is one of the most popular approaches to breast enlargement surgery.  The periareolar technique is also known as implantation through the nipple or implantation through the areola.  Although this cosmetic surgery technique is widely practiced and generally well tolerated, it is also full of general and specific risks, as well as a few benefits, which must be considered by any woman (or transgendered person) who is considering undergoing augmentation surgery.

Periareolar breast augmentation and inframammary augmentation are the two most commonly used surgical techniques used for placing prosthetic breast implants.  The periareolar approach consists of the surgeon making a crescent shaped incision which follows the natural areola pigmentation line on the bottom half of the nipple complex.  To put it in other terms, the cut is made between the bottom of the areola and the normal skin of the lower breast.  The incision is widened to allow the implant to be placed in the chosen location, (sub-glandular, sub-muscular, sub-fascial or dual plane) and the surgical wound is then closed.  While the surgery is simple in theory, there are many risks and complications which can occur.

General risks of breast augmentation are similar to many other plastic surgery procedures.  These risks include the possibility for noticeable scarring, the possibility for infection, the possibility for anesthesia-related problems, the chance of poor aesthetic results and in rare circumstances, serious injury or even death.

However, the scope of this particular article is to look at the procedure-specific risks of periareolar breast augmentation.  Implants placed through the nipple have a greater risk for scarring which may be impossible to hide.  This is because the incision is on the most obvious part of the breast mound.  If the scar does not heal to a fine and barely noticeable line, as is typical, then the patient may have to endure a very unappealing mark on the breast or consider undergoing corrective scar revision surgery.  The periareolar approach also involves a higher degree of risk for nerve damage or glandular injury in the sensitive nipple/areola complex.  This can lead to a variety of problems including loss of sensation or erectile function, as well as the reduction in ability or complete inability to breastfeed in the future.  One of the lesser known risks which is rarely revealed to women considering the technique is the fact that there are special bacteria which live in the nipple area.  Cutting through this region of the body can create a much larger risk for infection of the surgical wound, particularly in the deep tissues.  A deep tissue infection may not be obvious immediately, but can result in very dire complications, including systemic infection, capsular contracture of the new implants or even the necessity for implant revision or removal.

On the positive side of the equation, the periareolar breast augmentation approach allows easy and direct access to the area of the breast where the implant will be placed.  This makes the actual seating of the implant very easy.  Additionally, the periareolar incision will not degenerate the breast fold, preventing the early ptosis common to inframammary incision recipients.  When utilizing saline filled breast implant prosthetics, the incision in the areola can be truly tiny, since these medical devices are placed rolled up and empty and then filled once in position inside the body.  Utilizing silicone implants will require much, much larger and longer incisions and is generally not ideal for the periareolar procedure.

In summary, remember to research all your possible options when thinking about undergoing breast implant surgery.  Many women choose the transaxiliary approach to avoid breast scarring or the transumbilical approach to avoid scarring altogether.  The more you know, the better your chances of enjoying a safe and satisfying breast enlargement experience.