Breast Augmentation Incision Techniques
The ABPS-certified Plastic surgeons at Minneapolis Plastic Surgery, LTD. are committed to providing patients with the best surgical results possible. This means considering the pros and cons of all options for performing a procedure and fully tailoring them to the needs of the patient. This is an especially important consideration for breast augmentation surgery, which increases cup size and enhances curves. With this in mind, we’d like to go over the various incision methods for breast augmentation surgery.
Why Incision Techniques Matter
The incision techniques used during surgery will determine the location and visibility of scars following breast augmentation surgery. Unfortunately, many patients think that incision choice begins and ends with placement and scar visibility. However, there are many other factors to be considered, such as potential for bacterial contamination which can lead to higher risk for capsular contracture (and re-operation), sensory nerve injury, and damage to breast tissue that can cause scar tissue and microcalcifications which can interfere with the timely detection of breast cancers. Also, not all types of implants can be inserted via some incision options.
The four surgical methods mentioned below each have their pros and cons. These matters can be addressed in greater detail when you visit Minneapolis Plastic Surgery for a complimentary consultation.
Periareolar Breast Augmentation Incisions
The periareolar incision is generally made from the three o’clock to nine o’clock position at the junction between the normal breast skin and the darker adjacent areolar skin. Usually, this scar can be minimally visible when healed; however, this scar is visible when unclothed and can occasionally be unsightly, wide, thick, or irregular and it can produce a sharply visible line in an area where the areola color normally undergoes a gradual transition from dark to light. In addition, this incision requires cutting through ducts that end at the nipple, as well as the breast tissue itself, in order to create the implant pocket. This can cause internal breast scarring and/or calcification, which can make mammograms more difficult to read. Since the nerve branches to the nipple area are partially cut by this incision, a somewhat higher likelihood of nipple-areola numbness is present. Ductal bacteria may also increase the possibility of capsular contracture, so cutting through breast ducts is inadvisable, in my opinion.
Some surgeons may advocate the use of a periareolar incision along the top edge of the areola, excising a small crescent of skin above the nipple/areola complex in order to achieve a “crescent lift” for small degrees of breast droop or lower-positioned nipples. The amount of “lift” with this procedure is minimal to none, and because of this, I do not believe the benefits are worth the extra costs most surgeons charge for this procedure.
Transaxillary Breast Augmentation Incisions
The armpit (axillary) incision is often thought to create a “hidden” scar because the scar is not visible on the breast itself. However, the armpit scar can be visible when the arm is raised while the patient is wearing a swimsuit, sleeveless top, or strap-type blouse, and this scar may be wider or more visible than other areas because of its presence in a warm, wet, bacteria-rich environment which is constantly being stretched with every arm movement.
In addition, dissection from the armpit incision requires that the arm be elevated during surgery, raising the position of the breast and potentially causing malposition of the implant with relation to the crease. A higher proportion of high nipple, “bottoming-out” augmentations are caused by improper pocket creation that results from this incision choice.
Since silicone gel implants are pre-filled at the factory, implants larger than about 400cc are much more difficult to be inserted via this incision. Saline implants of a larger size can be inserted and filled once in place. Saline implants however, have higher rippling rates and do not feel as natural.
One final consideration with the axillary incision is that dissection from this vantage point is somewhat more likely to cause nipple sensation loss, since the (lateral fourth intercostal) sensory nerve to the nipple runs along this dissection route on the side of the chest wall.
Transumbilical Breast Augmentation (TUBA) Incisions
The umbilical incision involves use of an endoscope (a lighted tube commonly used to perform tubal ligations, appendectomies, gallbladder removals, and visual evaluations of the stomach or colon) to create a pocket beneath the breast or chest muscle for the implant. Only saline implants can be placed with this incision. The implant pocket is created by blunt dissection with a temporary tissue expander or the implant itself. Bleeding or inframammary crease malposition can require an additional incision on the breast, which negates the main advantage of using the umbilical approach (no visible breast scar). Very few plastic surgeons utilize this incision for breast augmentation. Silicone gel breast implants cannot be placed via this incision.
Inframammary Breast Augmentation Incisions
The inframammary incision (beneath the breast in the crease) is the most common incision used worldwide for breast enlargement with implants. We believe this incision provides the best exposure for creating an implant pocket with the least amount of bleeding (and the highest likelihood of controlling this bleeding should it occur), avoids the course of the nerve to the nipple in most cases, does not cut through breast tissue and/or ducts (minimizing the mammographic, breast-feeding, and sensation concerns), and leaves a short scar that is not visible clothed or unclothed unless one lifts the breast or looks from beneath. When the patient is reclining, the breast falls to the side and up, and the crease (inframammary) scar can be visible; in most cases it is nearly imperceptible. Both surgeons at Minneapolis Plastic Surgery use dissolving stitches beneath the skin surface—no cross-hatch or railroad-type marks, no sutures to be removed, and just a thin-line scar hidden in the natural inframammary crease.
Schedule a Consultation at Minneapolis Plastic Surgery, LTD.
For more information about breast augmentation surgery and how it can benefit you, be sure to contact our aesthetic plastic surgery center today. At Minneapolis Plastic Surgery, LTD. we look forward to your visit and will eagerly provide you with all the information that you need to achieve all of your aesthetic goals.
© Dr. Douglas L. Gervais, MD