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Breast augmentation is a cosmetic procedure that ultimately comes down to choices of the type of implant used, pocket location and what type of incision to use. Each of these decisions plays a role in the short and long term outcome of the surgery. All of these variables have been studied in numerous publications over the more than half century that the procedure has been performed. Much of these outcome assessments have focused on longer term issues such as capsular contracture rates, device failures and pocket stability.

Less work has been done on the very short term complications associated with breast implant surgery such as fluid collections and infection. These complications are well known to exist but identifiable factors that contribute to t their risk occurrence has been less studied.

In the November 2021 issue of Plastic and Reconstructive Surgery an article was published on this topic entitled ‘Incision Location Predicts 30-Day Major Adverse Events after Cosmetic Breast Augmentation: An Analysis of the Tracking Outcomes and Operations for Plastic Surgeons Database.’ In this paper the authors used the TOPS (Tracking Outcome and Operations for Plastic Surgeons) database to review almost 85,000 patients. From this data the early adverse events occurred in 0.37% of the patients. Seroma (0.08%), hematoma (0.15%), deep wound disruption (0.09%) and implant loss (0.11%) occurred. Independent multiple predictors were identified including over weight patients, tobacco use and diabetic conditions. The use of a periareolar incision was the one surgical technique identified as significantly increasing the risks of an early postoperative complication.

Because of the proximity of the periareolar incision to the breast parenchyma it has been suggested in the past that this may increase the risk of infection. Subsequent studies have filed to show a clear difference in risks for any of the breast incisions used but these studies may have been design limited to detect any differences.

The periareolar incision has its limitations beyond the risk of early complications. Based on the diameter of the areola and the desired breast implant size there may be limitations of what type and size of implant that can be passed through it.

Dr. Barry Eppley

Indianapolis, Indiana

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