Breast augmentation is one of the most commonly performed cosmetic surgical procedures performed in the United States. Each year, approximately 300,000 women undergo breast enhancement surgery. With the return in popularity of silicone or gel implants, the ideal incision type and length is being discussed more and more by plastic surgeons and their patients.
Breast Augmentation Techniques determine incision size and location
Inframammary Breast Augmentation
The most popular technique for breast enhancement surgery is the inframammary approach, also known as the crease incision. The skin incision is created at the inframammary fold, which is a crease under the breast where the breast meets the chest wall. After the incision is made the surgeon uses this opening to create the implant’s breast pocket underneath the pectoralis muscle.
The incision made is discrete and well hidden under the breast tissue while standing. Especially when combined with the keller funnel technique the size of this incision can extremely small, measuring around 3 cm. Obviously larger gel implants will dictate a larger scar.
Scar may be visible when raising the arms and lifting breast tissue.
Transaxillary Breast Augmentation
Transaxillary procedure is done by making an incision near the crease of the armpit. The surgeon exposes the pectoralis muscle and creates a breast pocket by under from underneath the arm.
Discreet incision made through the natural curve of the armpit. No scarring on the or under the breast. There is no need to cut through the chest muscle or the breast to place the implant. Low likelihood that nipple sensation is impacted.
The disadvantages include higher risk of capsular contracture and higher risk of malposition of the breast implant. In case of a patients requiring a revision surgery later on in life, most surgeons will not utilize the previous transaxillary incision site to access the implant. Scar will be visible when raising arms. There also exists risk of nerve and lymphathic drainage damage during surgery.
Periareolar Breast Augmentation
Breast implant is put just under the nipple with the incision made around the bottom of the nipple. This methodology also includes putting an entry point around the whole hazier external edge of the areola (areolar), The embed is then embedded through the opening and put into position.
The periareolar incision allows the surgeon to place the implant with the greatest direct visibility. Decreased risk of capsular contracture has been observed. A very subtle scar is created since incision is placed directly between the junction of the pigmented areola skin and lighter breast skin. Scar is only visible when all of breast is exposed. Revision breast surgery can be performed by entering the existing scar.
Technique can only be used with patients that meet minimum areolar width. This approach can cause problems with breast feeding down the line as well as impact nipple sensation.
Transumbilical Breast Augmentation (TUBA)
The transumbilical breast augmentation involves entering the umbilicus (navel) and creating a tunnel under the skin to access the implant pocket. This technique is performed with saline breast implants only.
Scar is in a remote location and barely noticeable.
This approach cannot be used for pre-filled silicone implants. Exact placement of implant is more challenging and less precise. Future access to implant will most likely be done through a different route for revision surgery.
Good incision results in less noticeable scars
Your surgeon will advise you on certain incision care techniques that can help improve the appearance of your scar regardless of the breast augmentation surgical approach.
Tips to Improve Scar Appearance
- Avoid stretching skin around the incision
- Avoid sun exposure and apply proper SPF
- Apply silicon gel when incision is completely healed
- Use surgical brown tape for weeks after surgery to assist with healing
- Do not apply harsh chemicals or strong soaps around incision site