In life it is always good to have choices and such is the case for breast augmentation. My preferred site is to use the inframammary approach. Sometimes I will utilize another incision if the operation is an implant exchange and the patient already has the incision. I never use the belly button and shy away from a peri-areolar incision. My main reason for NOT using a peri-areolar incision is due to the fact that the nipple is the “dirtiest” part of the breast as it has a high bacterial count. Well I just read a study where some plastic surgeons did some cultures of the breast skin and ductal tissue. They found that during a peri-areolar breast aug you had a HIGHER degree of contamination by using this approach. Many people feel, and I also believe that the introduction of bacteria can lead to the formation of a “biofilm” which can cause marked encapsulation. This is one reason I give my patients intravenous antibiotics just before operating.
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