If you are considering breast augmentation, you have to make sure that you get the best procedure for you. To do this, you need to weigh all your options carefully, including options for how to have your surgery performed. The most important decision is picking your plastic surgeon. If you find a plastic surgeon with whom you are comfortable, you can trust his or her expertise about many of the other parts of the procedure. However, it is also important to know about your breast augmentation options so that you will understand your doctor's recommendations and be able to give input when asked.
Understanding Breast Augmentation Incisions
There are four different incisions that are used for breast augmentation, but only three of them are relatively common.
The inframammary incisionis the most common incision used for breast augmentation. It is done at or near the breast crease or inframammary fold. This incision has many advantages. It allows the surgeon to have direct visualization of the breast as the pocket is being made. It may allow doctors to do more reshaping of the breast mound during breast augmentation. Because the incision can be longer here, this incision is ideal for inserting silicone breast implants.
Theperiareolar incisionis done directly below the areola, the colored tissue surrounding the nipple. This incision also allows for good visualization of the breast pocket, leading to good pocket formation. It can also be used for the insertion of silicone breast implants.
Thetransaxillary incisionis made in the armpit. An endoscope is used to allow the doctor to see the breast tissue as the pocket is being made. This incision can only be used for saline breast implants, since these come from the manufacturer uninflated and can be filled with sterile saline solution
TheTUBA (TransUmbilical Breast Augmentation)is performed using an incision in the navel. Then an endoscope is used to make tracks up to the breasts, where the pocket is created. Saline implants are maneuvered through these tracks to the breast pockets, where they are inflated. TUBA procedures have fallen out of favor and are now rarely performed.
Choosing a Breast Augmentation Incision
In choosing your breast augmentation incision, you have to consider the benefits and drawbacks of each of the incisions. Consider scar placement, quality of results, and likelihood of complications.
The inframammary incision leaves a scar below the breast that is well-concealed in most cases. If breast implants begin to bottom-out, or descend on the chest, the scar can roll up and over the breast, but if your implants are bottoming out, you most likely need revision surgery anyway. It gives very good results for most people, and has a low rate of complications.
The periareolar incision leaves a scar just below the areola. Many women are concerned that this might make the scar more visible, but this is not generally the case. First, scars from periareolar incision are generally lighter than scars from inframammary incision because the tissue around the areola is thinner. Second, the scars are well-concealed in the change in tissue from areola to breast. The disadvantage is that placement through a periareolar incision may increase the odds a woman will experience an infection or capsular contracture. Some say this incision may increase the risk of a woman being unable to breastfeed after breast augmentation, but this has not been confirmed.
The transaxillary incision leaves scars that are not on the breast. This can be a good or a bad thing. If the scar heals well, it is just a tiny line in the armpit, but if it heals poorly, it is in a location that will be exposed any time a woman wears a sleeveless dress or blouse, swimsuit, or tank top. Transaxillary breast augmentation can give good results if a doctor is experienced with the technique, but it has a greater likelihood of resulting in breast asymmetry (unevenness). If any revision surgery is required, it cannot be performed through the original incision. Instead, a second incision is required, usually at the inframammary crease.
TUBA has fallen out of favor because it has many of the same problems as transaxillary breast augmentation, but worse. A woman with a TUBA may get infection, bleeding, or fluid accumulation in the tracks to the navel. For these reasons, TUBA has fallen out of favor and is not generally recommended.
No Substitute for a Consultation
Really the only way to know whether a particular incision will work for you is to talk to a plastic surgeon who can talk to you about his experience with the different techniques. Surgeons are all different, and so are patients so it is impossible to know what is best for you without a consultation.
