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Incisions used for breast implants

Breast implants are typically put in through one of three incisions. The breast crease incision (inframammary fold) is the most commonly used incision. The areolar incision (around the nipple) and the armpit incision approaches are also used. A fourth, less desirable way to place breast implants that is seldom used is through the belly button. There is no perfect incision and all incisions have trade offs, some incisions have more positives while other have very few.

The most important factors to be considered when selecting a breast incision for augmentation are safety, control, consistency of result, secondary surgery approaches as well as the size and shape of the breast. The breast incisions’ scar appearance should be considered only after these much more important factors have been evaluated.

The most common incision used to place breast implants that is preferred by the majority of surgeons is the breast crease incision also known as the inframammary fold incision. This incision is considered the gold standard approach because it allows for the most important factors described above to be optimized. The inframammary fold incision allows for better exposure and therefore, better safety, control and consistency of result. This incision is also the preferred incision for secondary surgeries and emergencies.

With the inframammary incision, the surgeon can visual the muscles and establish the breast implant position faster and with less breast trauma than the other incisions. This incision also allows direct visualization and control of the breast implant pocket size and also allows the plastic surgeon to compare the breast pocket sizes for symmetry. Another way to explain this bonus is that this incision allows for the right and left pockets to be created and then compared before putting the breast implants in. The inframammary incision is the only incision that provides all of these benefits and no breast injury.

The only negative factor of the inframammary incision is that the scar technically is on the breast and may be visible. The ‘bad press’ about this incision that is on the internet presents poor scar results as the normal result rather than the exception. The scar length concern should only be an issue with prefilled silicone gel breast implants, because they require a larger incision to place these breast implants in. The saline filled breast implants are not an issue since these breast implants are not prefilled and are typically put in empty so a very small incision should be used. The scar length should really not be any longer than 3 centimeters. Some plastic surgeons will use larger incisions because it allows them to perform the breast augmentation faster. In some cases, the scar may not end up in the crease but on the breast. The scar may also thicken or widen a bit. When taking all things into consideration, the inframammary incision has proven itself as an excellent choice to gain access to place breast implants and no injury to the breast ducts or breast glands.

The areolar incision is also a common choice for breast augmentation. This incision is usually along the bottom half of the areola and the incision arc’s along the areolar cutaneous border. It has a lot of the same benefits of the inframammary fold incision, but is also has more negatives. The periareolar incision can also be visible; it can distort the areolar edge, and does damage breast tissue during the breast implant surgery.

The armpit incision also called the transaxillary incision is less commonly used because it can limit the plastic surgeons control, symmetry, visualization, and secondary access to the breast pocket. The only advantage is that of marketing and the ‘hidden scar’. The armpit incision requires that the arms be strapped on boards away from the body in a crucifix position. The incision should be in the hair bearing skin of the armpit and when it is used, the breast augmentation surgery is performed on one side at a time. In other words, the pocket in made under the muscle and then the breast implant is placed in at that time. There is no way to confirm pocket symmetry since only one side is operated on at a time. The breast augmentation result is only checked after both breast implants are in place. If there is a pocket manipulation required to correct an asymmetry it is done with a long instrument and without any visualization. So if a bleeding problem develops it may not be diagnosed until after the end of the surgery. If there is a problem, the plastic surgeon will most likely create an incision under the breast to see where the bleeding is coming from. So in this case, she will have two incisions from her breast augmentation. It is for this lack of control that the transaxillary incision has more risks and is markedly less often utilized by the plastic surgeons.