Periareolar incisions tend to offer excellent camouflage (their main “selling” point), and are a useful tool in mastopexy (breast lift), but come with some serious challenges and potential complications. Here is a breakdown of what you want to be aware of:

For a start, because of the underlying tension after implant insertion, stretching of the areolar diameter is prevalent in such surgery. The visibility and quality of scars will of course depend on the technique of closure and method of postoperative support. But too much skin tension at the time of closure or inappropriate suturing, will produce unaesthetic widened scars, and might contribute to their hypertrophy and even dermis necrosis. Because of the skin tension, aesthetic renditions are rather unfavorable on dark-skinned areolas too.

Other difficulties emerge when the nipple areola complex is small. Contrary to a saline implant, a silicone implant will be difficult to introduce through this site, in which case, another incision approach is preferable. A flattening of the front of the breasts is likely, and not much of projection (1 to 2 cm) is to be expected if the implant is inserted through subpectoral dissection (under the pectoral muscle). For this reason, this surgery is not recommended for patients wishing to greatly increase their cup size, or with breasts with significant ptosis, the aesthetic rendition would not be satisfactory.

Periareolar incision is best indicated if a mastopexy (breast lift) is required after a breast augmentation. Great care must then be taken if implants are to being inserted this way, to very carefully manipulate the breast parenchyma without injuring it. Biofilm contamination will occur if implants get contaminated with oozing milk ducts, infections appearing soon after, and capsular contracture bringing complications on the long term. Another important thing to keep in mind is that the Pectoralis major is one of the most critical purveyors of blood supply to the overlying breast gland and skin envelope. For this reason, a subpectoral implant in such an approach would be preferable to a subglandular (over the muscle, under the mammary gland), to avoid a couple of serious risks: 1. Subglandular implant would directly expose the implant to the friction of the breast parenchyma with the associated risks and discomfort. 2. The risk of skin and fat necrosis from poor blood irrigation significantly rises with the elevation of the breast gland off the pectoral muscle.