Breast augmentation through a halo. Periareolar mammoplasty to enlarge the breasts through the areola

One of the negative aspects in patients who have undergone augmentation mammoplasty with a good aesthetic result is postoperative scars, so surgeons have always tried to shift the surgical approach to cosmetically more acceptable areas. One of them is the periareolar pathway.

The periareolar approach involves placing the implant through an incision in the pigmented part of the areal and has the advantage of a less noticeable scar.

This incision can be recommended for patients with an areola with a diameter of at least 3-4 centimeters, with a tendency to form keloid scars, since in the pigmented areas of the areola there is minimal likelihood of the formation of a keloid or hypertrophic scars, also in cases where there is a need to reduce periareolar excess skin.

The same access can also be used to eliminate breast asymmetry, anomalies of the base of the gland (tubular breast), and spinal curvatures

Marking for breast augmentation through the areola

As with breast augmentation using the inframammary approach, the following orientation lines are drawn - the midline and the line of the inframammary fold (groove), the medial and lateral points indicating the width of the implant, the upper and lower points indicating the height of the implant (in this case, the lower point can be located on the line of the old inframammary crease or on the line of the new inframammary fold). In addition, markings are applied to eliminate the asymmetry in the position of the nipple-areolar complexes and inframammary folds.

Breast augmentation technique through the areola

After the patient is given anesthesia, the mammary gland plastic surgery itself begins.. A skin incision is made along the preoperative marking line.

Next, a pocket for the implant is formed either subcutaneously (between the gland tissue and the skin), or the gland tissue is dissected to the pectoralis major muscle, the latter is intersected in the area of the abdominal portion of the attachment.

After this, the pocket is checked for bleeding vessels, and hemostasis is performed. Before inserting the implant, a drainage is installed to drain wound fluid and blood. Next, an implant is inserted to enlarge the breast. The plastic surgeon inserts the implant into the created pocket, straightens it, and checks its exact location.

After everything has been checked, the plastic surgeon sutures the wound and skin layer by layer,

Tatyana (32 years old, Odintsovo), 05/30/2017

Good afternoon, Maxim. It's my birthday soon, so I want to give myself a gift in the form of breast augmentation. It is important to note that I want to have my breasts done in the summer, and during this period I begin to become allergic to the pollen of flowering plants. I can’t say that my condition is becoming critical, but I feel very bad. Is it possible to have breast augmentation during this period? What pills to take during rehabilitation. Thanks for the answer. Tanya.

Good afternoon, Tatyana. I do not recommend breast augmentation surgery during an allergy flare-up. It is worth waiting until there is no allergy to undergo surgery. Sincerely, plastic surgeon Maxim Osin!

Irina (26 years old, Korolev), 05/27/2017

Hello, Maxim Alexandrovich! I am planning to enlarge my breasts, but at the moment I am still feeding my daughter (Breastfeeding). Tell me, after what period can enlargement surgery be performed? Irina

Good afternoon, Irina. Breast augmentation surgery can only be performed six months after the last day of lactation. Sincerely, plastic surgeon Maxim Osin!

Liliya (25 years old, Moscow), 05/25/2017

Good morning! It so happened that by nature I have very small breasts. I'm worried about surgery. I'm afraid there will be very visible scars. Traces from the operation will remain. Perhaps you can recommend how else you can enlarge your breasts without implants? Are there recommended injections? Best regards, Lilya.

Hello, Lilia! At the moment, I consider the only acceptable method of breast augmentation to be plastic surgery using implants. After the operation, traces remain minimal, and post-operative scars are difficult to see. Do not worry, as the result after this operation will certainly pleasantly surprise you. Sincerely, plastic surgeon Maxim Osin!

Kristina (27 years old, Moscow), 05/24/2017

Good afternoon, Maxim Alexandrovich. My friend had her breasts done by you, and now I want to have my breasts enlarged, because after pregnancy I am not at all happy with their shape. Tell me, what forms are there? My friend chose the round shape of the implants, but for my taste round looks unnatural. What advice could you give in this matter?

Good afternoon There are enough implants to choose the shape that suits you. The shape can be: anatomical, spherical, teardrop-shaped and round. I can only recommend a particular form of implant after I have seen your breasts and their condition after pregnancy. I suggest you sign up for an in-person consultation. Sincerely, plastic surgeon Maxim Osin!

Olga (25 years old, Moscow), 03/15/2017

I live in another city. How many days should I set aside for breast augmentation surgery? Is it possible to get tested in your city and come only for the operation?

It's possible. First you need to select the day of the operation. We send you a list of tests and you take them in advance in your city. On the eve of the operation, you must come for a consultation, at which the doctor will select implants for you, taking into account your wishes and anatomical features. After the operation, you are in the hospital for a day, then you are discharged and you come back to have the stitches removed in 3-4 days. And the doctor releases you. That is, you will need 4-5 days for the trip.

Olga (28 years old, Moscow), December 18, 2016

Hello? Maksim. I want to enlarge my breasts. How can it be if I have stretch marks on my chest??

Good afternoon The presence of stretch marks does not affect the operation. Unfortunately, it is impossible to remove stretch marks. With the help of cosmetic treatments they can be made less noticeable.

Anastasia (27 years old, Moscow), November 29, 2016

Hello, Maxim Alexandrovich! My husband and I go to the gym, the load is not significant, but still... I want to get implants and would like to know how long it will take to return to sports?

Good afternoon, Anastasia! As a rule, you can return to sports within a month and a half after surgery. However, it will be necessary to obtain the doctor’s permission after he assesses the integrity of the stitches.

Victoria (32 years old, Moscow), November 28, 2016

Hello, I am a male transvestite, and I want to make myself a woman’s breasts (enlarge). What is needed for this, to what size can it be increased, and how much will it cost??? Thank you in advance.

Good afternoon. The cost of the operation is 250,000. The size and shape of the implants can be determined during a consultation. The implants are installed under the pectoral muscle, the incision remains almost invisible.

Kristina (18 years old, Moscow), 09/20/2016

Hello, Maxim Alexandrovich! I have a zero breast size, I would like (ideally) a fourth... I myself am slim, they tell me that there can be a big load on my back. This is true?? I am 18 years old. Best regards, Christina!

Hello, Christina! There is no actual limitation when it comes to breast augmentation, but an experienced professional will consider each individual case. In your case, it is probably not advisable to increase to a size four. Because there will indeed be a large load on the back and the risk of unnatural-looking implants. In addition, you will need several operations, since surgeons do not perform breast augmentation by 4 sizes at once. More precisely, I can answer your question during a face-to-face consultation. Come and we will help you!

Irina (23 years old, Moscow), 09/18/2016

Hello, Maxim Alexandrovich! I had a breast augmentation ten years ago (two sizes, now three). Recently, my breasts have sagged a little, and it has become noticeable that I am wearing implants. Is there any way to fix this? Thanks in advance, Irina.

Hello Irina! We can perform breast lift surgery and implant replacement, which will completely solve your problem. Come to us for a consultation and we will help you!

Of the well-known and frequently used approaches for mammoplasty, the most popular are: submammary, periareolar (breast augmentation through the areola), axillary, transumbilical, transareolar, transabdominal.

Most girls and women don't like the shape of their bust. Today this problem can be solved. Carrying out surgery to install a special implant is one of the real ways to help the situation.

Most often, mammoplasty uses a method that involves making an incision along the areola (the pigmented area of the nipple part). The incision usually blends in with the color of the areola and is practically invisible. If the scar is painted in a lighter shade, then it can be hidden with the help of micro-tattooing.

This method is also called areolar. In this method, a woman uses an implant, which can be placed either on top of the mammary gland or directly below it.

The surgical process for an areolar incision

When deciding to place the implant under the muscle, a small crescent-shaped incision is made in the lower part of the areola, bordering the skin. Thus, periareolar surgery allows the surgeon to create a pocket by subcutaneous detachment in the lower part of the breast to place an implant or create it under the breast.

After such manipulations, the breast implant is inserted through the same incision. Today it is one of the most popular options for performing the operation.

Currently, implant placement by areolar incision is the second most commonly performed procedure.

Positive aspects of the areolar incision method

When deciding to perform surgery in this way, you should take into account its negative and positive aspects, as well as take into account the fact of contraindications.

The main positive characteristic of this method is that after surgery there is no characteristic fold under the pectoral muscle, which remains with some other types of surgery, in particular with the submammary approach.

A small incision at the nipple, no more than 2 cm, as well as an incision in the armpit, is not associated with the fact of breast augmentation surgery, especially in a person who is far from surgery. A cut at the very border of the areola provides an additional camouflage effect.

In this way, directly under the mammary gland, or under the pectoral muscle.

Possibility of scarring

The main determining factor in the healing of the operated area is genetic factors. If a woman’s wounds do not heal well, and rough hypertrophied scars remain, then it is better to choose another type of surgical intervention in order to enlarge the breasts. In addition, of course, the skill of the surgeon is not the least important in the effectiveness of the result of such an operation relative to the quality of the scar.

Additional options for areolar surgery

Also, with this method, it is possible for the surgeon to make other adjustments to the mammary gland at the time of the operation to enlarge it:

for slight ptosis, mastopexy (breast lift) is performed;
correction of the asymmetry of the areolas or the location of the mammary glands.

Note! If the areolar complexes are too large, they can be trimmed or excess skin can be removed.

Negative aspects and difficulties during the operation

Among the disadvantages of breast augmentation surgery through the nipples, the possibility of side effects should be taken into account:

with an abnormal scarring process. After healing, the scar may be clearly visible in the center of the chest;
when the connecting muscles are separated, to form a niche into which the implant is inserted. When installing it under the pectoral muscle, a woman may feel increased discomfort for a long time;
this type of surgical intervention may lead to loss of sensitivity of the succulent part of the breast, or, conversely, hypersensitivity, which is practically impossible with other types of incisions;
possible development of capsular contracture from the presence of specific bacteria in the tissues of the mammary glands that fall on the implants when they are inserted through the areola;
complications are possible that lead to repeated operations, and a second incision is made under the breast fold;
with a small breast areola, the choice of implant size is limited;
a miniature incision can lead to injury to the mammary gland, ducts and its individual lobules, since the subcutaneous layer in this part of the breast is quite small;

In addition, the difficulty of surgical intervention lies in the limited visual inspection of the pocket formed before inserting the implant.

Breastfeeding field breast augmentation using the areolar method

With this type of operation, a woman is at greater risk of losing sensation in the nipple part of the breast than with other methods, since the incision is made in close proximity to the nipple.

Although the experience of installing implants in this way is quite common, surgeons try not to do them on young patients who plan to have children. But for older women, especially those who require additional cosmetic breast lifts and breast modifications, this type of surgical intervention is used.

Recovery period

The recovery time after breast augmentation surgery by making an incision under the areolar part is, in principle, similar to this period after operations by other methods.

The main discomfort is not caused by the place where the tissue incision is made, but by the fact that after the implant is inserted, muscle tension occurs due to the introduction of a foreign body. Also, unpleasant sensations resulting from the detachment of connective tissue to form a niche for the implant may be disturbing.

In the postoperative period, it is very important to follow the doctor's recommendations. If any unusual situations arise, you should definitely consult your doctor. The presence of pain is quite logical after breast augmentation, as after other surgical interventions, but additional treatment may be required, including removal of the implant itself. Women who have an implant placed under the pectoral muscle experience more intense discomfort than if it was placed on top of it.

As a rule, the installation of drainage tubes is not required in the postoperative period. But a woman who has undergone surgery should wear a special type of compression garment, in the form of a sports bra, to ensure a reduction in swelling, as well as eliminate discomfort and ensure that the implant is in the required position.

Within a day, the operated woman can be discharged from the hospital. During this period, she is not contraindicated in taking a shower using gentle detergents and a soft washcloth.

After about a week, a large number of patients can return to their normal routine, only by limiting physical activity. After 2-2.5 months, you can perform physical exercises as usual.

Breast augmentation is a popular, in-demand, and therefore widespread operation. Much is known about it, however, future patients are always concerned about the question of whether the scar will remain and will be noticeable after the intervention, in what place it will be located, and so on. To answer these questions, you need to know how the breast implant will be installed. In this article we will look at the main types of surgical approaches for augmentation mammoplasty.

First of all, we note that the final decision on the type of access is made by the doctor. From a professional point of view, he evaluates all available indications, analyzes the structural features of the body and chooses the most suitable and safe type of access. The following methods of installing implants for augmentation mammoplasty are distinguished:

Breast augmentation through armpits

In this case, the surgeon makes an incision in the armpit area. The endoprosthesis is installed under the pectoral muscle or under the mammary gland, but does not touch the breast tissue. Accordingly, there is no dissection of the milk ducts that provide breastfeeding. During the operation, the doctor uses endoscopic equipment, so there is no risk of damaging any vessels or lymph nodes.

After healing, the scar in the armpit area becomes almost invisible, and there are no traces on the chest. Most often, augmentation is performed in this way if the patient has a small amount of her own gland tissue and the absence of a pronounced inframammary fold.

In terms of technique, axillary access is considered the most difficult method of breast augmentation, since it requires high professionalism from a plastic surgeon. The specialist must be fluent in working with complex endoscopic instruments, as well as control his actions so as not to touch the vessels.

Typically, this access is not recommended for patients wishing to enlarge their breasts to size 4 or more, as well as for women with asymmetrical breasts. In some patients, scar healing takes longer due to the large number of hair follicles in the armpits.

The percentage of patients whom I operate through the axillary approach using the endoscopic method is quite large. The technique is quite popular and known to young patients, which is why there is a great demand for it. But it should be understood that axillary breast augmentation has a range of indications that must be taken into account when performing the operation. Some people have to refuse to install implants through the armpits. Fortunately, there are other methods that also provide excellent aesthetic results with minimal postoperative scars. Another feature of the axillary approach is the rehabilitation period, which requires patients to strictly comply with all the instructions of the plastic surgeon, especially if she had an anatomically shaped implant installed. Wearing compression garments ensures that the implant “heals” correctly and prevents it from moving or rotating, which, as we know, can deform the shape of the breast.

Patient of Svetlana Pshonkina. An example of breast augmentation through an incision along the lower edge of the areola

With the areolar approach, the incision for installing implants is made along the lower contour of the areola (less often, along the perimeter of the areola). Thus, the seam will run along the extreme contour of the pigmented area of the areola. Thanks to this location, provided proper healing occurs, the postoperative scar becomes almost invisible. The areolar approach is suitable for installing an implant of any shape (round or anatomical), with any shell (smooth or textured).

This access allows the plastic surgeon to perform not only augmentation with an implant, but also other surgical procedures. For example, correction of areolas, elimination of asymmetry and breast lift. Among the features that the plastic surgeon should notify the patient about is temporary loss of sensation in the area of the areola and nipple.

Svetlana Pshonkina comments

Just a couple of years ago, areolar breast augmentation was associated with surgery for women who have given birth. This was explained by the fact that during installation of the implant the mammary gland was necessarily dissected, therefore, subsequent breastfeeding became impossible. Today, the methods of performing areolar breast augmentation have changed, the philosophy of the operation itself has changed - not only aesthetics are extremely important for us, but also the health of the mammary gland and the ability to feed the baby with breast milk.

Breast augmentation through an incision under the breast

Many plastic surgeons call breast augmentation through the submammary (inframammary) fold an outdated method. Some even pointedly refused to perform the operation through this access. However, the technique has not completely died, and plastic surgeons still use it.

Submammary breast augmentation allows you to achieve high precision when installing an endoprosthesis. The surgeon makes an incision in the inframammary fold without affecting the breast tissue. The method is easy to perform; the surgeon can form a pocket for the implant as accurately as possible, as well as control and promptly stop possible bleeding from small vessels.

With competent work by the surgeon and the presence of a formed submammary fold, the scar will be practically invisible. However, otherwise the seam may become noticeable. In addition, when an endoprosthesis is implanted, the inframammary fold is stretched, causing additional stress and potential stretching.

Features of the access include its effect on the final shape of the breast. The technique involves the use of the so-called “double plane” during the formation of the “bed”. This ensures the most correct position of the pectoralis major muscle in relation to the implant.

What is most interesting to patients who decide to undergo breast surgery? First of all, of course, future implants are their size and shape. An equally important question is “how will they be given to me?” and “will the seams be noticeable”?

Type of surgical approach for breast augmentation or lift– one of the main factors for the success of the operation, which largely determines its aesthetic result. The plastic surgeon “,” Candidate of Medical Sciences, surgeon of the highest category, talks about the types, advantages and disadvantages of each of the possible approaches:

Surgical approach for augmentation mammoplasty

The main types of mastopexy, depending on the type of surgical approach, include:

Periareolar mastopexy. It is performed using two circular incisions: the first along the circumference of the areola, and the second at some distance from the first. Excess skin between the incisions is removed, their edges are joined, and the postoperative scar runs along the border of the areola and unpainted skin. Performed for small to moderate excess skin to correct ptosis and breast asymmetry. Scars with this type of lift become almost invisible 2-6 months after the operation.
Vertical mastopexy. It is performed using circular incisions, supplemented by vertical ones, which are necessary to excise excess skin in the lower parts of the chest. This type of plastic surgery is used for severe ptosis of the mammary glands, since in this case, simply removing excess skin between circular incisions will not give the desired aesthetic effect - the breast will become flatter, and the outer edge of the incision will be noticeably “gathered”. An additional vertical incision allows you to remove excess skin in the lower parts and give the breast a natural teardrop shape. The incisions, of course, will be much more noticeable than the incisions around the areola, but modern suturing methods allow us to obtain a good aesthetic effect in this case as well. Thin and light vertical scars are not noticeable and do not spoil the overall positive aesthetic effect of the lift.
To eliminate extremes, surgeons use additional horizontal incisions under the breasts(in submammary folds), which allows you to achieve the most natural result of the operation (this lift is sometimes called an anchor breast lift). The additional scar under the breast is almost invisible after surgery, but it allows you to create a more beautiful and natural breast shape.

The choice of mastopexy method primarily depends on the aesthetic objectives of the operation and the patient’s goals, with preference, of course, being given to the type of surgical approach with minimal postoperative scars.