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Breast Augmentation and the Informed Patient

Last week in the Glendora office, I saw a patient who is interested in breast augmentation. Almost always it seems like patients are more and more becoming very informed about the procedure. Their questions are becoming increasingly more advanced. In particular, this woman asked specifically about nipple sensation and lactation after a breast augmentation. This is a very insightful question and many women fail to ask or be concerned about this issue. While lactation potential is generally not disturbed during breast augmentation, there certainly could be an increased risk for lactation issues through a periareolar incision. However, this is very rare. During the periareolar approach, plastic surgeons often try to dissect around these glands to avoid them. However, this is not always the case, sometimes these ducts are entered. This can have potentially a few unwanted issues. Number one, there is a bacteria that lives inside these glands called staph epididymis. This has been implicated in capsular contractures, although the link is not entirely clear. I doubt there may be anything but a small increased risk of capsular contracture through this approach as opposed to an inframammary approach. Number two, is the potential to interfere with lactation. I think it is exceptionally rare for patient to be unable to lactate after a periareolar breast augmentation; however, interruption in these glands is certainly a possibility. Lastly is nipple sensitivity. There is most definitely an increased risk of nipple sensation loss or hypersensitivity from operating on the breast, and through the periareolar approach this incidence is likely higher. However, I would say less than 20% complain of decreased nipple sensitivity and even less complain of hypersensitivity.