How Incision Placement Can Affect Nipple Sensation
There are many variables to take into account and decisions to be made when electing to undergo breast augmentation surgery. One of these is which incision approach to use for implant insertion. There are three acceptable incision options, each of which has its advantages and disadvantages based on the individual’s needs and desires. These incisions include:
Considered the most common approach for breast augmentation, this incision is made in or near the inframammary fold—where the bottom of the breast and chest meet. In general, this incision often provides the most short- and long-term flexibility, better exposure during surgery, more predictable outcomes, and a variety of other benefits that can be discussed at the time of your consultation.
This incision is made along the margin of the lower half of the nipple-areola complex, where the nipple adjoins the normally colored breast skin. While this incision placement is requested by some patients due to its relatively inconspicuous location, potential issues such as an elevated risk for the loss of nipple sensation, a greater likelihood of capsular contracture, and a propensity for breast contour irregularities (caused by scarring) should be taken into consideration.
Located in the armpit, this incision option has the major benefit of producing no postoperative scarring on the breasts themselves. This is the second most popular incision placement, and the results can be excellent for the appropriate patient, particularly when performed endoscopically. However, like the periareolar incision, there are several potential issues associated with this approach that should be considered before selecting it.
There is another incision location used by a small minority of physicians, the transumbilical approach, which is located in the belly button. In my opinion, this is a “gimmicky” approach fraught with multiple, significant problems with no rational advantages. I would never consider using this option for my patients.
Which Incision Is Best?
The incision that I have always preferred for breast augmentation is the inframammary incision, with rare exceptions. The reasons are many, including the relatively inconspicuous location and healing of the incision, better surgical exposure to facilitate precise technique and control, a reduced risk of developing capsular contracture (tight scar formation around the implant causing the breasts to feel hard), and what seemed to be a lower risk of affecting the sensation of the nipple-areola complex (NAC). No large-scale study had been conducted to prove or refute my sentiment on the effect of incision placement on nipple sensation until recently.
A large scientific study was conducted in Italy that evaluated the possible effect of the incision location on the postoperative sensation of the nipple-areola complex. The study assessed data from over 1,200 women who had their surgeries performed by the same plastic surgeon over a period of six years. Among the variables investigated were patient age, the implant size, and whether the implants were placed above or below the muscle.
The study found that the implant size had no significant impact on the sensation of the nipple-areola complex postoperatively, an outcome that may surprise many. In addition, neither the patient’s age nor the location of the implant (under or over the chest muscles) had any influence on sensation. The only variable that had a statistically significant association with reduced NAC sensation after surgery was the incision location. The periareolar incision affected 9.5 percent of women compared to 3.5 percent with the inframammary incision. This translates into 2.7 times greater risk of sensory loss. It also had 3.5 times greater risk of causing areolar pain.
Now there is even more convincing evidence supporting the superiority of the inframammary incision over the periareolar incision for breast augmentation.
Ultimately, the particular incision utilized will be determined based on your specific aesthetic goals as well as surgeon preference and recommendations. For my patients, the inframammary incision is recommended and employed a vast majority of the time due to its considerable advantages over the other approaches.