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Breast augmentation incisions

Posted By mjbrown On December 3, 2008 @ 4:18 pm In | No Comments

There are three generally accepted ways to access the breast area to place breast implants during breast augmentation plastic surgery. ALL incisions have trade offs and compromises. There is no one perfect incision or best incision used for breast augmentation. The three primary incisions are below the breast along the inframammary fold (breast crease), around the breast areola, and through the armpit. A fourth way that is advocated by only a relatively few plastic surgeons is through the belly button.

Things that should be considered when selecting a breast incision for augmentation are the safety, control, consistency of result, secondary surgery approach, and the size and shape of the breast. The scar appearance is best considered only after these other variables have been considered.

The most popular breast augmentation incision choice that is preferred by the great majority of plastic surgeons is under the breast along the breast crease or inframammary fold. This is the gold standard approach because it allows for the best exposure of the breast surgical area. With better exposure comes more safety. It is also the preferred secondary approach for breast implant plastic surgery.

After cutting the skin, the plastic surgeon can see the muscle and establish the breast implant position faster and with less breast trauma than the other approaches. This breast augmentation incision choice allows for significant control of the breast implant pocket size and also provides the plastic surgeon the ability to compare pocket sizes. In other words, the plastic surgeon will usually create the right and left breast pockets before putting in the breast implants. This way the surgeon can verify symmetry in pocket size and allow for more consistent results. The only negative aspect of the inframammary incision is the ‘visible’ scar. This may have been an issue in the past when prefilled breast implants (silicone) were placed through large incisions. Since they were prefilled, the incision had to be longer to fit the implant into the pocket. This particular characteristic was problematic for all three incision types, not just the inframammary fold approach. With the saline breast implants for augmentation, the scar should be really small because these breast implants are placed into the breast pocket empty and then filled up. The problem on the internet is that there are a lot of poor result scars presented as the ‘norm’ rather than the exception. So scar length should really not be any longer than 3 centimeters for saline and 5 centimeters for the majority of  silicone breast implants. Some plastic surgeons may elect for larger augmentation incisions for the larger implant sizes and to increase their speed. Sometimes when larger implants have been selected by the woman, the scar may not end up in the crease but rather on the breast itself. This is seldom a problem but rarely the scar may thicken and widen a bit. Overall, the inframammary incision provides consistently excellent access to the area for breast implants placement with no trauma to the breast ducts or breast gland.

The periareolar incision or around the areola incision is also a common way to gain access to place breast implants. It has a lot of the same benefits as the inframammary fold approach but does cut through breast ducts, gland and may leave a visible scar along the areolar border. Because this breast incision is next to pigmented tissue it is more likely to cause more pigmentation around the scar thus making it more visible.

The armpit or transaxillary incision is less commonly used and limits the plastic surgeon as far as control, symmetry, visualization and secondary access to the breast pocket. The real only advantage of this incision is that the scar ‘should’ be placed in the hair bearing skin of the armpit. This incision requires that the arms be away from the body and that each breast side is done to completion prior to operating on the other side. Therefore, symmetry of the result is only checked after the breast implants are in and filled up. At this point, any manipulation of the pocket is done without seeing what is being done and may lead to an increase risk of bleeding postoperatively. If there was to be a bleeding complication after breast augmentation, the plastic surgeon would most likely create an incision under the breast to ‘see’ where the bleeding is coming from. So the woman will then have two scars. It is for these reasons that the transaxillary incision has more risks and is markedly less often utilized by the plastic surgeon. When this armpit incision is used with  camera guidance, the risks are markedly diminished but it is still a surgery done on one side at a time. Unfortunately, the camera requires more skill and time, and some plastic surgeons using this incision will not ‘wait to use the camera’.

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