Although many surgeons would tell their patients that the breast augmentation incision they use is the best, without explanation, I prefer to give patients all of the options and explain their pros and cons.
There are three incisions that are primarily used and one that is reserved for the more adventurous. First is the more adventurous belly button incision. This is performed by few surgeons in this country. The incision is made in the top part of the belly button and instruments are inserted up to the breast. The breast pocket is then developed under limited visualization. Most breast implants are placed under the gland only; the muscle is not typically elevated as this is too difficult under this limited visualization. I think that this incision is a gimmick. Any of the other incisions provide better visualization and the implant can be placed under the muscle. In addition the incision and tunnel are too small for silicone implants to be used.
The second incision is the transaxillary or armpit incision. From here the pocket can usually be developed well enough for both saline and silicone implants to be placed. There are two main problems with this incision. First, it can take more time to do the surgery, since reaching the lower part of the breast where the muscle is divided can be a challenge. Second, the incisions are visible anytime the patient raises her arms. I am a strong believer in developing new techniques. However, the new technique must be an improvement on the current technique. Although I will use this incision if the patient asks, I don’t think it is an improvement over the next two incisions.
The next and more commonly used incision is the periareolar incision. This incision is made at the border of the areolar and breast skin. There are advantages and disadvantages to this incision. First, if the wound heals without a problem the scar will be almost imperceptible. Second, if any kind of mastopexy or breast lift is required than this is the incision of choice. From a disadvantage point of view is again the incision. Although uncommon, incisions in darker skinned patients can become hypertrophic or keloid which would be very visible. Finally, healthy breast tissue must be divided in order to place the implant. I think that any elective surgery that could potentially distort a future mammogram or breast exam should be considered extensively before proceeding.
The last incision is performed in the inframammary fold. Most surgeons make this incision in the fold under the breast. Unfortunately, when the implant is placed the scar ends up above the fold, on the lower breast, as skin is pulled up. In contrast I make this incision 1cm or about 1/2 inch below the fold. So after the implant is placed and the skin is pulled up, the incision ends up exactly in the fold. This camouflages the incision well. In addition this incision allows direct access to the muscle without injuring the breast tissue.
Therefore, my preference is the inframammary fold incision as it damages the breast tissue the least, it camouflages the best, is the fastest approach and will only be seen by the patient and anyone she is intimate with.
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