Breast augmentation patients are very tech savvy and the majority have surfed the internet to learn about the procedure, the implant options and, of course, the surgeons in their area. As a result, many patients understand that numerous decisions must be make with respect to breast augmentation. Previous blog posts discussed the differences between silicone and saline implants as well as the various above and below muscle options. In this post, the topic of incisions will be reviewed. There are four main options for incision placement in breast augmentation: under the arm (Transaxillary), around the nipple and areola (Periareolar), under the breast (Inframammary), and through the belly button (transumbilical). As with any surgical decision to be made, each one has certain advantages and disadvantages.
Under the breast (Inframammary):
This particular incision is probably the most commonly utilized incision. It provides direct visualization of the space beneath the breast. Because of this direct route, this incision is frequently used for revision procedures and may accommodate either a silicone gel or saline implant. The incision also allows for the implant to be positioned above or below the pectoralis muscle. With a bra or bikini in place, the incision is well hidden. However, if you do not have enough volume or laxity of the breast tissues to form a skin crease beneath the breast, this scar may be more noticeable when nude.
Around the nipple and areola (Periareolar):
This particular approach to breast augmentation also provides direct visualization of the space beneath the breast tissue and may be used for revision surgery. Both silicone gel and saline implants may be utilized with this technique. However, the placement of larger silicone gel implants may be more problematic of the patient has a smaller diameter areola. As with the inframammary incision, the scar is well hidden in a bra or bikini. Unfortunately, if the scar heals poorly, then it will be slightly more obvious when nude due to its position on the front of the breast. Consult with your physician and follow the postoperative instructions for optimum results.
Under the arm (Transaxillary):
If the incision is placed beneath the arm, the subsequent scar may be completely hidden and is located away from the breast. However, other challenges present themselves. Unlike the inframammary or periareolar incisions, the transaxillary incision does not allow for direct visualization unless an endoscope is used, which then adds surgical time and expense. Since the surgeon is unable to directly see the pocket being created for the implant, the risk of an improperly positioned implant is slightly greater. In addition, this incision is not suitable for revision surgery and a second incision must be made in these situations. Lastly, it is difficult to place silicone gel implants trough this incision without risking damage to the implant or surrounding tissues.
Through the belly button (Transumbilical):
As with the transaxillary incision, the scar may be well hidden and away from the breast. However, it is impossible to insert a silicone gel implant through this approach and appropriate placement from this longer distance is significantly more difficult. As a result, this incision is rarely used by most plastic surgeons for breast augmentation.
Though each of these techniques may produce excellent results, it is a decision that is best made by you and your plastic surgeon together. It is important that you utilize an incision with which you feel comfortable; it must also be one with which your plastic surgeon has significant experience in order to give you a superior result.
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