An intra-areolar approach performed through a small incision is a superior technique for breast augmentation because it avoids skin scarring and the pitfalls of alternative methods. At the same time it yields natural-appearing results using any type of implant, said Leonard A. Rubinstein, M.D., developer of the technique.
“The pigmented, wrinkled areolar tissue does not develop keloids or hypertrophic scars, and provides excellent camouflage for an accordion-like incision” said Dr. Rubinstein, a cosmetic surgeon with private practice offices in Sarasota, FL.
After the markings are made with the patient in standing and sitting positions, the procedure can be performed under anesthesia, or IV sedation with local tumescent anesthesia. The incision measures about 2 cm in length from tip to tip, but because of its configuration, when stretched it provides an entry site of about 4 cm to 5 cm.
“By affording direct visualization, this approach ensures complete hemostasis while facilitating accurate implant placement and positioning. Any type of implant can be placed through the intra-areolar incision, even silicone gel-filled devices, and malpositioning of teardrop-shaped implants does not occur, as it can when those devices are delivered from peripheral sites in the umbilicus, axilla, or inframammary fold,” Dr. Rubinstein said.
The intra-areolar approach also provides the best opportunities for evaluating saline-filled implants for air and evacuating residual bubbles. Enduring the sound of sloshing that occurs secondary to incomplete air evacuation is a bothersome problem for many recipients of saline-filled implants placed through other techniques, Dr. Rubinstein said.
Relative to other approaches for breast augmentation, the intra-areolar technique also offers advantages for avoiding loss of nipple sensation and implant hardening. Dr. Rubinstein explained that the nerves supplying the nipple-areolar complex arise from the region of the inframammary fold, and so using the intra-areolar approach, only fine, distal nerve branches are severed, if at all, and these will regenerate or re-innervate adequately.
The intra-areolar approach also minimizes a number of factors that have been associated with implant hardening, including inadequate hemostasis, excessive tissue trauma, and bacterial contamination.