Augmentation Incisions

  • Periareolar
  • Inframammary
  • Transaxillary
  • Transumbilical

Periareolar:

The incision which goes around the edge of the dark areola that surrounds the nipple (usually the lower half)  is used to insert the implant.

Pros:

  • The scar usually blends wells well with the surrounding tissue.
  • The same incision can be used again if later surgeries are needed.
  • The space for the implant can be seen clearly with direct vision.

Cons:

  • The incidence of infection after surgery may be minimally greater.
  • Breastfeeding in the future may be interfered with in some but not in most patients.
  • Nipple sensation may be decreased, but it is usually temporary.
  • While the scar usually blends in at the edge of the areola, there is also a chance it could be lighter or darker than the adjacent tissue.
  • If the areola is too small, the incision may not be a good option for larger silicone gel implants.
  • Potential slightly higher risk of capsular contraction.

Inframammary:

The incision is placed at the bottom of the breast near the crease called the inframammary fold. This is the most  commonly-used incision today.

Pros:

  • The same incision can be used again if later surgeries are needed.
  • The space for the implant can be seen clearly with direct vision.
  • Slightly lower risk of infection.
  • While it is a visible scar, the position underneath the breast in the fold means it is usually not visible while standing without clothes.
  • Potential slightly lower risk of capsular contraction. 

Cons:

  • The scar can be visible on the breast when lying down.
  • Placement higher or lower on the breast will make the incision visible.
  • If there is a secondary procedure to place a larger implant, the scar may be located higher on the breast. If a smaller implant is placed, the crease may be raised, exposing the scar in a lower position, possibly in view under a bra or swimsuit.
  • Longer appearing incision than around the areola.
  • May not blend in as well as a periareolar scar.

Transaxillary:

The incision is made in the crease of the armpit. Some surgeons use an endoscope ( internal camera) to assist in creating the space for the implant while others use a blind  approach.

Pros:

  • There is no scar on the breast itself.

Cons:

  • If a camera is not used there is no visualization of the surgical pocket which may result in less control.
  • A higher risk of asymmetry.
  • An increased chance of bleeding requiring re-operation.
  • If there are complications during the procedure, a separate incision may have to be made on the breast.
  • The armpit scar can be a problem when larger silicone implants may not work well with this choice.
  • The armpit scar will be visible when wearing sleeveless shirts.
  • A potential be permanent numbness of the surrounding tissue under the arm and onto the shoulder.
  • The same incision cannot be used again if later surgeries are needed, which would require a separate incision on the breast.

Transumbilical:

The implants are inserted through the incision in the belly button. Some surgeons use a camera to assist and some do not. There are many drawbacks and most surgeons do not recommend this approach.

Pros:

  • The scar is usually hidden in the belly button.

Cons:                                      

  • There is no visualization of the surgical area. It is a blind procedure.
  • Increased risk of complications to the surrounding tissue and bleeding.
  • Saline implants are the only option for this incision choice.
  • The scar could be visible and quite noticeable.
  • Placing the implants correctly can be difficult causing a greater risk of asymmetry.
  • If there are complications during the procedure, a separate incision on the breast may be necessary.
  • The same incision cannot be used again if later surgeries are needed, requiring a separate incision on the breast.
  • This option is much more difficult to perform reliably.

 

 

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