Have you decided to get your breast augmentation done shortly? Are you wondering about the right location of the incisions to be made for slipping the implants in your breasts? Well, this is probably the most common concern for any woman planning to undergo breast augmentation surgery, as the choice of the incision may leave noticeable scars on the skin. While many options are available, the selection should always be based on goal, comfort level, and the surgeon’s skill. Before you go out to talk to your surgeon about the incisions, arm yourself with the knowledge and understanding of all of them. So, here is our comprehensive guide to choosing the best one from the breast augmentation incisions.
What is Breast Augmentation?
Breast augmentation or Augmentation Mammoplasty is a cosmetic surgery procedure that helps women achieve their dream breast contour. In this method, implants are placed under the chest muscles or breast tissue through incisions. At last, the incisions are closed in the breast tissue by using stitches (layered sutures), surgical tape, and skin adhesive.
Breast augmentation increases the size and fullness of a women’s breasts while enhancing their shape and elevation aesthetically. It also aids in rebuilding breasts for different conditions (naturally small size, asymmetry, distorted shape after pregnancy, breastfeeding, surgery, or severe weight loss, etc.). Eventually, it boosts the self-esteem, confidence level, and sexuality of women to a great extent (1).
Breast Implants and Their Types
Breast implants are a type of medical prosthesis used for augmenting or reconstructing breasts for a better appearance. Once placed inside the breasts, they typically last from 7-12 years on average. However, knowing about the types of breast implants is essential to decide on the right location of the incision. The three most common types of breast implants are:
1. Saline Breast Implants: A saline implant contains an elastomer silicone shell filled with different amounts of a sterile saline solution (saltwater). The sizes and projections of these implants can vary widely, making them easily customizable to the unique needs and goals of individuals. They are usually filled with saline solution through a small tube after inserting into the breasts, which requires only a tiny incision. In case of leakage, the saltwater is absorbed and discharged by the body naturally.
2. Silicone Breast Implants: In this kind of implant, a silicone gel is used in a silicone outer shell, imitating the texture and feel of natural breasts. Women usually prefer silicone breast implants as they are very soft to touch and provides a realistic appearance. It needs a somewhat larger incision as the implants come pre-filled with the silicone solution. In case of leakage, the implant may collapse by releasing the gel into the breast pocket or stay intact by holding the gel as it is inside the shell.
3. Alternative Composite Breast Implants: Unlike saline or silicone breast implants, this type of implant comes filled with polypropylene string. Sometimes soy oil or some other materials are also used for this purpose.
Placement of Breast Implants
When it comes to choosing the perfect location for breast augmentation incisions, the placement of the implants within the breasts also matters a lot. The ideal placement of breast implants depends on several factors, including the patient’s anatomy, the quality of her breast skin, unique cosmetic goals, and the size of the implant. There are three common implant placement options that you should know about:
1. Subglandular Implant Placement: The implant is placed under the breast tissue but above the chest or pectoralis major muscles.
2. Partial Submuscular Implant Placement: The implant is placed under the breast tissue and partially under the chest or pectoralis major muscles.
3. Full Submuscular Implant Placement: The implant is placed right under the chest or pectoralis major muscles.
4 Best Options for Breast Augmentation Incisions
There are four standard incision techniques, which most surgeons have widely practiced during breast augmentation surgeries. Here is a lowdown on all of them (2):
1. Inframammary Incision (Breastfold Incision)
- This is the most popular technique in which a small incision is made under the breast where it folds (a little above where the rib cage meets the breasts).
- It provides the best access point to the surgeon to create a pocket for the perfect placement of the implant with better control and great precision.
- If you are going for silicone implants, this is the best option for you. So also, if you are looking to club implants with a breast lift, which can be performed with the same incision.
- This procedure does not damage the nerves in the nipples.
- It also does not affect the milk ducts, which reduces the chances of infections.
- The incision scar can be reopened to replace the implant and other subsequent surgeries with no additional scarring.
- The best thing about this incision is that the scar will remain well-hidden under your moderately sized breasts even when you wear a skimpy bikini.
With the inframammary incision, it is difficult to change the size of the breast implants in the future. A new incision needs to be made for this purpose as the existing one cannot be reused. Also, the scar may become more noticeable if it moves upward from the breast fold and stretches out gradually.
2. Trans-Axillary Incision (Armpit Incision)
- This incision is performed under the arm, in the natural fold of the armpit.
- It is an advanced surgical technique in which an endoscope and a lighted camera are used to create a tunnel to the breast and carve out a pocket for implant placement.
- A tiny incision is made, which is typically 1 inch – 1.5 inches in length. It is ideal for women with the requirements of smaller implants (200cc to 350cc in size).
- Unfilled saline implants are used here as silicone ones will need an incision almost 2.5 inches long. This may leave a scar that would show through sleeveless clothing.
- Being a blind procedure, it does not give enough control to the surgeon of the overall positioning of the implant. Hence, it may need multiple revisions.
- As the breasts remain untouched, they do not get scared, and the mammary glands also do not get damaged.
The incision scar stays hidden within the armpit and blends with the skin well once fully healed.
The trans-axillary incision does not support a second breast augmentation surgery. So, a complete new incision should be made for a fresh surgical procedure.
3. Periareolar Incision (Nipple Incision)
- This incision is made on the perimeter of the darker-colored (pink or brownish) area around the nipples, called ‘areola.’
- It causes minimal scarring as the scar does not show through the naturally pigmented area of the areola.
- The proximity of the incision point to the implant location gives direct visibility and better control to the surgeons.
- If you want to undergo a small breast lift along with your breast augmentation surgery, consider this incision without any doubt.
- The incision can be reopened and reused for other breast surgeries in the future and that too without additional scarring.
A periareolar incision is not apt for larger silicone breast implants. Moreover, it can interfere with the milk ducts. So, avoid this option if you are planning a future pregnancy. The method poses higher risks of altered nipple sensation, capsular contracture, etc. The incision scar may also appear raised and more noticeable if it is not healed properly. Corrective surgery may be needed for that purpose.
4. Trans-Umbilical Incision (TUBA Incision)
- This incision is performed right above the belly button, and a channel is made through the abdomen up to the breast to create a pocket.
- An empty implant is transported through the channel and guided up to the breast for placement in the pocket.
- Considering the small space around the navel, only inflatable saline breast implants are used in this method. Silicone breast implants are too big for this incision.
- The breasts remain untouched throughout the procedure, and hence, no damage is caused to the mammary glands and the nerves in the nipples.
- It leaves a scar within the wrinkles of the belly button, which is almost undetectable. Also, the scar gets healed faster than other breast augmentation incision scars.
The Trans-Umbilical Incision is performed far away from the breasts, which needs extensive training, experience, and skill. The less control over the procedure also gives lesser precision and sometimes even undesirable outcomes. The incision may pose a risk of implant distortion and cannot be reopened for future surgeries too.
Which is the Best Breast Augmentation Incision?
Consulting with a board-certified plastic surgeon will help you find the best incision choice for your specific anatomy and unique aesthetic goals. He or she will go over all suitable options and their advantages and disadvantages to make breast augmentation surgery a success for you. However, the inframammary incision is the most common and widely accepted one. It gives the best access to the incision point and ensures the most precise placement of the implant. On the other hand, the periareolar incision and the trans-axillary incision make it to the second and third positions in the list, respectively.
Also Read – Laser Bra Breast Surgery To Lift Your Breasts
Potential Risks and Complications
The surgical procedure always comes with its challenges, no matter which incision pattern you select for enhancing your breasts. Potential risks and complications involved in it are pain, tenderness, hardening, red and thick scars, infection, bleeding, fluid accumulation, temporary sensational changes (in breasts and nipples), implant rupture and leakage, capsular contracture, implant distortion, anaplastic large cell lymphoma, need for additional surgery, and so on. Breast implant illness with systemic symptoms like skin rash, fatigue, joint pain, memory loss, trouble focusing or concentrating, etc., is also quite common in some cases (3).
Breast augmentation is a cosmetic surgery procedure that helps women achieve their dream breast contour by placing implants under the chest muscles or breast tissue through incisions. Choosing the right location of the incision for slipping the implants in the breasts is highly important as it may leave noticeable scars on the skin otherwise. The implants can be a saline implant, a silicone implant, or an alternative composite implant while the placement can be either subglandular or submuscular. Based on these, breast augmentation incisions can be categorized into the inframammary incision, trans-axillary incision, periareolar incision, and trans-umbilical incision. The inframammary incision is known to be the most common and widely accepted one so far as it gives the best access to the incision point and ensures the most precise placement of the implant. The periareolar incision and the trans-axillary incision make it to the second and third positions in the list respectively.
Frequently Asked Questions (FAQs):
Which Incision Technique Leaves a Less Visible Scar?
Among all those incisions performed directly on the breasts, the inframammary incision is known to leave a less visible scar.
How Long Does It Take for Breast Augmentation Incisions to Heal?
It usually takes anywhere between 6 and 8 weeks for breast augmentation incisions to heal. However, the recovery time may increase in case of infections, leakage, or other complications.
Is Healing Time Different for Different Techniques?
No, all breast augmentation incisions take a more or less a similar time to get healed.
Is It Normal for Incisions to Hurt after Breast Augmentation?
Having pain and tenderness around the incision site for 2-3 weeks is normal following a breast augmentation surgery.
- “Is Bigger Better? Breast Surgery Linked to Boost in Self-Esteem and Sexuality”, News.UFL.edu
- “Your Guide to Choosing the Right Incision for Your Breast Augmentation,” DrSanders.com
- “Breast Augmentation,” MayoClinic.org