Breast Implant Incision Options: Making an Informed Choice

Introduction:

When considering breast augmentation, one of the crucial decisions to make is the choice of incision for inserting the breast implants. The incision site not only affects the overall aesthetic outcome but also has an influence on the recovery period and potential scarring. In this blog post, we will explore the various breast implant incision options available, highlighting their benefits and considerations to help you make an informed decision.

Inframammary Incision:

The inframammary incision is the most common and popular option among breast augmentation patients. This incision is made in the natural crease under the breast, providing direct access to the implant site. The size of the incision can be small in saline implants to about 2 inches (or 5cm)for the largest silicone implants.  Benefits of this approach include:

Optimal visibility for the surgeon during implant placement.

Ability to place a range of implant sizes and types.

Minimal interference with breast tissue, reducing the risk of complications.

Well-concealed incision that tends to heal nicely over time.

Disadvantages:

A scar is on the breast and can be visible without clothing in arms up position.

Periareolar Incision:

The periareolar incision is made along the lower edge of the areola, where the darker pigmented skin meets the surrounding breast tissue. The idea behind this incision is that the areola and skin border is a normal transition zone so a line that is fine at the right location may become nearly invisible.  This incision offers several advantages:

Camouflage within the natural color transition of the areola.

Direct access to the implant site with precise control over implant placement.

Potential for simultaneous areola adjustment or nipple repositioning, if desired.

The resulting scar often blends well due to the natural color variation.

Disadvantages:

Higher rate of capsular contracture, limitation on incision size due to patient areola, change in nipple sensation, potential effect on breast feeding.

Transaxillary Incision:

For those seeking an incision away from the breast itself, the transaxillary incision is a suitable option. This approach involves making an incision within the armpit, through which the surgeon creates a tunnel to insert the implant. Key benefits include:

No scarring on or near the breast itself.

Hidden incision within the armpit, easily concealed by clothing.

Minimized interference with breast tissue, reducing the risk of breastfeeding complications.

Suitable for saline implants or smaller silicone implants.

Disadvantages: higher rates of malposition, capsular contracture, visibility of the scar in arm raised position with sleeveless outfits, and size limitations of the desired implant.

Using a Mastopexy Incision (during a breast lift)

For patients undergoing a simultaneous breast lift with and implant (augmentation mastopexy), the implant will typically be placed through an incision that would otherwise be part of the breast lift so no additional scarring is needed to place the implant that would otherwise be present with a breast lift.

For patients undergoing a inverted T type lift, I will always place the incision with an inframammary fold approach then close the incisions from deep to superficial before starting the lift procedure.  This keeps the implant separate from the more superficial maneuvers that might lead to some contact with skin and raise the potential for capsular contracture.  For lifts that are only vertical or lollypop incisions we will use the vertical incision to place the implant and again close the pocket before performing the breast lift.  And finally for those that only the need a donut lift we may opt to place the implant through a fold incision and then perform the donut lift separate to limit the disruption to the breast and minimize potential for the implant touching the skin.

Transumbilical Incision:

The transumbilical incision, also known as TUBA or belly button incision, is a less common approach but offers some advantages for specific patients. Here are some considerations:

Incision made within the belly button, resulting in no scarring on or near the breasts.

No interference with breast tissue.

Limitations: Only suitable for saline implants, and implant placement may be more limited compared to other techniques.

Requires specialized surgical expertise.  This is more historical as most surgeons do not offer this approach due to the limitations and increased complications of malposition, infection, capsular contracture.

Conclusion:

Choosing the right breast implant incision option is a personal decision that should take into account your desired outcome, preferences, and the advice of your plastic surgeon. Whether you opt for the well-concealed inframammary incision, the subtly blended periareolar incision, the inconspicuous transaxillary incision, or the unique transumbilical incision, discussing your goals and concerns with a qualified surgeon will help ensure the best possible results.

Remember, each incision option has its own benefits and considerations, and what works for one person may not be the ideal choice for another. By understanding the available options and engaging in an open dialogue with your surgeon, you can make an informed decision that aligns with your aesthetic goals and overall well-being.  As I prioritize safety first I will typically recommend the safest incision which is based on evidence an inframammary fold approach.