Dr. Laverson avoids breast enlargement through areola in the following cases:

• If your areola is very small, Dr. Laverson prefers to avoid it.  Large implants can be particularly difficult to insert through a small areola.
• If you plan future pregnancies and/or nursing, this may be another reason to avoid the areola.
• If your areola has a poorly defined or irregular border that may not conceal a scar well, it is preferable to choose another approach.
• If nipple sensation is important to you for sexual stimulation, Dr. Laverson avoids the areola. Additionally, capsular contracture may be more likely if the implant is placed by the areola approach. Bacteria living within breast ducts are more likely to seed the implant pocket when these ducts are opened during surgery. The largest ducts are near the areola and are undisturbed by other approaches.

If the inframammary crease is poorly defined, asymmetric, or must be lowered an indeterminate amount to achieve a good result, the areola or armpit may be preferred. If a peri-areolar breast lift is to be performed with the augmentation, there is no need for an additional scar, so the periareolar approach is preferred. Large, darkly pigmented areola skin and a well-defined areola border that will conceal a scar well also favor the areola approach. If uncertain whether or not breast lift (mastopexy) is necessary, the areola approach may be recommended.