Incision Options For Breast Enlargement Surgery
Dr. Placik offers his patients choices regarding incisions for the insertion of breast implants. During your consultation, Dr. Placik will make a recommendation for your breast enlargement surgery based upon your physique, pre-operative breast size and shape, previous surgery, and your level of physical activity. There are four main incisions available for breast augmentation.
Inframammary (in the fold under the breast):
An incision, one inch (for saline implants) to two inches (for silicone implants) long, is made in the fold in the shadow under the breast (the underwire location). This is by far, the most popular incision for several reasons. It has been estimated to be used in 80 percent of surgeries. Through this incision, a pocket is made either behind the breast or behind the pectoral muscle for subglandular or submuscular placement of the breast implant. The implant is inserted into the pocket. In either instance, the implant is placed under the breast rather than through the breast and is less likely to interfere with the potential for lactation and nursing. This incision is best for Silicone Breast Implants, which come from the manufacturer pre-filled and therefore require a larger incision for insertion. This incision makes for the shortest procedures and the lowest incidence of complications. There are many surgeons and scientists who believe that this results in the lowest incidence of contamination and a biofilm.
The only disadvantage of this incision is that there may be a noticeable scar under the breast. This would be especially true if there is no defined fold in the breast prior to the operation or there is no hanging of the breasts overlying the fold. In general, ninety percent of these incisions heal with excellent scars.
Periareolar (around the lower border of the nipple/areola):
This incision is made at the margin of the pigmented portion of the areola and the skin of the breast. Pockets for the implant can then be made either behind the breast or behind the pectoral muscle. The implants are inserted and adjusted for symmetry. This incision produces almost universally excellent scars, meaning that healing is quick and scars are minimal. The periareolar approach allows for the placement of the implant either above or below the pectoralis muscle. This is another potential incision for use with silicone breast implants in patients with average size areola (3.5cm or more), because the incision is large enough to allow the insertion of the full implant. However, some physicians believe it may cause a higher risk of biofilm formation and subsequent capsular contraction. It tends to be preferred in individuals who are at higher risk for hypertrophic or keloid scar tendencies.
The axillary incision is made through a crease in the armpit. Occasionally, it requires the insertion of an endoscope, a long tube with a camera that allows Dr. Placik to perform the procedure with a very small incision when using saline implants. The pocket for the breast implant can be made in front or behind the pectoral muscle. The advantage of this approach is that there are no scars on the breasts. This approach tends to be slightly more uncomfortable in the immediate post-operative period, and this approach is difficult to perform for silicone breast implants. A bad or hairless scar may be visible in bathing suits or tank tops.
Umbilical (belly button):
This is also known as the TUBA or Trans-Umbilical-Breast-Augmentation approach. A small incision is made in the belly button and a tunnel is made from the incision to behind each breast. The deflated saline implants are rolled up like cigars and passed up these tunnels. They are inflated, checked for symmetry, and the incision is closed. As with axillary incision, this approach has the advantage of not putting scars on the breast. The tiny umbilical scar is practically unnoticeable. Studies have shown that this procedure has a high level of satisfaction. Although there was an initial burst of enthusiasm for this procedure, it has subsided. Dr. Placik has stopped recommending this approach; He has corrected numerous TUBA procedures and has since abandoned the surgery.
For more information, see Questions About Scarless Breast Augmentation.
If you are interested in learning more about the variations of breast enlargement surgery, consult our breast enlargement FAQ or call or email Dr. Placik today for your initial consultation.