It is important to know that even though the nipple areola is kept attached, there is a very high likelihood of having nipple areola numbness after Periareolar top surgery, because so many of the nerve endings present in the tissue underlying the nipple and inferior to the nipple are no longer providing sensation. As with the Double Incision approach, this numbness is likely to resolve with time because nerves will usually regenerate into the nipple over time. However, permanent numbness is a possibility.

The limited ability to control for nipple position may influence you into choosing the Double Incision approach over the Periareolar approach, if you feel that the aesthetic of the Double Incision is more in line with your surgical goals. We recommend you look in the mirror at where your nipple currently lies and imagine all the breast tissue below disappearing, after which your nipple will retract against your chest wall. If you can visualize where this location will be, think about whether you would be happy with the vertical and horizontal location of your nipple.

The Periareolar approach is best performed in patients with minimal to no extra skin, because only a minimal amount of skin can be removed without causing unnatural pleating on the chest wall. The more skin that is excised, the more tension there is on the nipple areola complex, putting it at greater risk for ischemic complications (loss of blood supply).

There is a limit to how much skin can be excised through this approach because the more skin that is excised, the more tension there is on the nipple areola, putting it at greater risk for is chemic complications (loss of blood supply).This is very important because with the inferior areolar skin incision required to allow access to remove underlying breast tissue, blood vessels that were previously supplying the nipple areola through underlying tissue and inferior tissue are now unavailable, and thus the nipple areola relies on blood supply coming in from the superior skin flap. Undue tension on the nipple areola after surgery could put the nipple at risk for poor blood supply. It is extremely important to avoid nicotine products in any form before and after Periareolar top surgery because nicotine limits the amount of oxygen delivery in the blood that reaches your healing nipple areola.

Periareolar top surgery is best for patients with minimal to no skin excess and a small volume of breast tissue, but with an areola diameter that is larger than desired. If the areola diameter is small enough, a Keyhole approach is an alternative option. Patients who are not ideal candidates for the Periareolar approach due to the size of their chest or the amount of skin excess would be better served with a larger-scar approach such as the Double Incision. Performing Periareolar surgery on patients who are not ideal candidates places them at risk for chest wall pleating, nipple blood supply issues and need for possible revision surgery.