The Best Incision for Breast Augmentation

July 14, 2016

There are several important decisions patients will need to make when contemplating breast augmentation surgery, such as:

  • What type of implant, saline or silicone and if silicone, what type?
  • Where will the pocket for the breast implant be placed? Above or below the muscle?
  • What size breast implant?
  • Where will the incision be?

Your Board Certified Plastic Surgeon will help you make these important decisions giving you the pros and cons of each.

I would like to address the placement of the incision and explain my preference. There are three popular locations preferred by most surgeons. The main goal is to have the scar be as inconspicuous as possible, with the least amount of complications.

The Three Main Breast Augmentation Incision Sites

The first incision is the periareolar incision that is a half-moon shape around the lower areola. The scar is well hidden due to the change of skin texture and color of the areola. For many years this was the approach I favored, and once healed was well hidden. With the incision site so close to where the implant will go, the surgeon can easily control the bleeding, and the placement of the implant is quite precise. The incision site can be used again in the future should breast revision be necessary.

Some studies show that this incision may be responsible for higher incidence of capsular contracture because dragging the implant through the breast may contaminate the implant with bacteria in the breast, the same bacteria implicated with capsular contracture. There is a higher risk of loss of nipple sensation, and the milk ducts may be compromised leading to difficulty with breastfeeding. The size of the areola may limit the size of the implant. Even though my complication rate was very low, I now favor the inframammary incision.

The inframammary incision is located at the crease under the breast where it meets the chest wall. The incision is just slightly above the fold so that it is not visible if a bathing suit top should ride up. The scar is further hidden by many women who have a mark from wearing a bra. Since the breast gland is not cut with this incision, it has the least amount of swelling. All implant types can be used with minimum trauma. Also, this incision can be used for any type of breast revision surgery.

The third popular incision is the transaxillary incision, an incision in the armpit. Tunneling to the breast is usually done with an endoscope but will increase surgery time. It is possible for this incision to be visible, depending on how it heals, any time a woman should raise her arm while wearing a sleeveless top. If revision surgery is needed, it can be very challenging and sometimes may require a new incision. However, this approach is some surgeon’s preference, but they may find limitations in trying to insert silicone implants, especially large ones.

There is one other approach that remains controversial, called trans-umbilical breast augmentation (TUBA). With this approach, the surgeon tunnels to the breast through the belly button. The main advantage is there is no visible scar. However, the disadvantages are many, only saline implants can be used, and the surgeon is dissecting the breast pocket blindly making it difficult to position the implant correctly, leading to higher rates of complications.

Dr. Miguel Delgado, M.D. states there are pros and cons to each approach. The decision is a personal one for each individual, and he will spend a great deal of time with each patient to assist in making all the decisions related to breast augmentation.

If you have been struggling with important breast augmentation decisions, call (415) 898-4161 to discuss all of your concerns with Dr. Delgado.

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