Mild Nipple Asymmetry: Using a Supra-Areola Incision With Crescent Nipple-Areola Complex Lift to Address This Problem in Primary Breast Augmentations

Abstract

Breast augmentation mammoplasty is one of the most commonly performed cosmetic procedures in the United States. Currently, the common access incisions employed to perform the procedure are periareolar, inframammary, transaxillary, (TUBA) transumbilical, and (TABA) transabdominal (a technique that places breast prosthesis through existing abdominal scars or during the performance of an abdominoplasty). Asymmetries of the breast and chest wall are a common occurrence that is faced by aesthetic surgeons who perform breast augmentations. We aim to describe how our experience with using the supra-areola incision, for a primary breast augmentation procedure, has the added advantage of allowing us to address this problem. This article is a retrospective review of primary breast augmentation cases that were performed in our General Cosmetic Surgical Group and Fellowship Training Program from January 1, 2007, to June 30, 2015. The review addresses the incidence of nipple asymmetry in our primary breast augmentation patients and how we are able to address this problem by performing a crescent nipple-areola complex (NAC) lift via a supra-areola incision. From January 1, 2007, to June 30, 2015, 281 primary breast augmentations were performed, of which 184 (65.8%) had an NAC lift to address subjective and objective mild nipple asymmetry (~1 cm). There were no intraoperative complications. At follow-up, more than 92% of patients report satisfaction with their aesthetic outcome, 98% admitted to resolution or improvement of nipple asymmetry, 99% admitted to adequate postoperative nipple sensation, while 8% had secondary/revision breast surgery in the form of capsulectomies, scar revisions, and implant change revisions. Supra-areola incision approach should be strongly considered as a first-line approach in patients undergoing a primary breast augmentation procedure with adequately sized NAC and have evidence of mild (maximum study average = 0.95 cm) nipple asymmetry.