Effect of incision choice on capsular contracture after breast augmentation

Most patients tend to think that the type of incision used for breast augmentation doesn’t make a difference, and that they all work equally.  Turns out, that isn’t the case at all.  The incision placement actually makes quite a difference on the frequency of complications.

In this month’s issue of ASJ (the Aesthetic Surgery Journal) is a nice little study by Dr. Scott Spear and colleagues, comparing the rates of capsular contracture (breast hardness after implant placement) in 183 breast augmentation patients.  Dr. Spear is a respected plastic surgeon, and an expert on breast augmentation, having been very much involved with the FDA review panels on the topic.

The patients were divided into three groups, based on whether they had an inframammary crease incision, a nipple incision, or the transaxillary (armpit) incision, and were followed for an average of 13 months after surgery.

The researchers found that the incision placement did make a significant difference.  Capsular contracture and hardening of the breast happened most often with the transaxillary incision (6.4%) and the periareolar incision (2.4%).  The infra-mammary incision had the lowest rate of complications, at only 0.5%

This report supports a previous publication which found the same kind of results – inframammary incisions have the lowest capsule rate.  And since CC is the most frequently encountered complication after breast augmentation, it really makes sense to do everything possible to reduce the chance of this problem happening.

In this study, there was no difference in capsule rates between saline and silicone gel implants, which is the same trend as the data in the Mentor – FDA follow-up study.

Bottom line:  If patients want to have a periareolar incision, they are putting themselves at risk for a five-fold increase in capsular contracture rates, and the subsequent surgery to fix it.  That’s a pretty major difference, and a big trade-off.  I typically recommend the infra-mammary incision to my Orlando breast augmentation patients, based on this data.


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