In this article I will be discussing the pros and cons of the different types of incisions done for breast augmentation. Plastic surgeons in San Francisco perform many cosmetic surgeries and breast augmentation is one of the most frequent.
The most significant issue related to location choice concerns the scar that will remain after surgery. It is understood that there will be some scar formation following any surgical procedure. Any incision though the skin results in some scarring. The visibility of the scar is related to the location, surgical skill, possible problems with healing, and personal differences in scar formation.
There are generally 4 different types of incisions that can be used when performing Breast implant surgery. The four types of incisions are the areolar incision, infra-mammary or crease Incision, trans-axillary Incision, and the T.U.B.A. or (Trans-umbilical Breast augmentation) incision. Each has its own pros and cons. Ultimately the final choice of incision type will be made in consultation with your plastic surgeon. But it’s always a good idea to learn as much as you can prior to having that discussion with your doctor.
The incisions are usually 1 to 1.5 inches long except in the case of the TUBA incision. The TUBA incision is shorter due to the increased elasticity of the abdominal skin. The length of the incision is somewhat determined by the skill of the physician and the type and size of implant you choose. A silicone implant which is pre-filled will require a slightly larger incision than a saline implant that is inserted empty and filled later on. Textured implants also often require a larger incision. A saline implant is inserted empty and filled later therefore it usually requires a smaller incision than silicone gel implants. A silicone gel implant is larger at the time of insertion.
The areolar approach is performed by making an incision at the lower border of the light and dark skin of the areola in a semicircular shape. Often a protective sleeve is used when inserting the implant to prevent injury to the breast ducts. If a mastopexy (breast lift) is being performed at the same time, this would be the approach of choice because the mastopexy also requires an incision in the same place. The areolar incision usually results in an excellent cosmetic appearance. Disadvantages of the areolar incision possibly include a more noticeable scar if healing does not go well. There is also a slightly higher risk of altered nipple sensation following this procedure.
Breast implants can also be inserted with an infra-mammary incision. The incision is usually just above the crease where the bottom of the breast meets the chest wall. This is the most often used technique for breast augmentation. This like the areolar incision is a location that makes it easy for the surgeon to position the implant. A benefit to this location is the ability to reuse the same area if there is a need for revision in the future.
The trans-axillary incision is placed in the arm pit. Once the incision is made, the surgeon can then create a channel to the area where the implant will be located. The implant is then moved into place usually with an endoscope (a flexible tube shaped device with a fiber optic camera). The biggest advantage to this technique is that there will be no scar on the breast when completed. A disadvantage to this approach is that future revisions will require an incision at a different location.
The Trans-Umbilical Breast Augmentation or T.U.B.A. incision is done by creating a small incision at the navel. An endoscope is then used to tunnel up to the breast area, going through subcutaneous fat, just under the skin. This tunnel is used to pass a rolled up saline implant up to the chest area. The implant is unrolled and filled with saline. The T.U.B.A. procedure leaves no scars on the breasts. However, “tracks” may form where the tunneling was done. These usually disappear with time but not always. Silicone implants may not be used with this technique.
Your final choice will be made with your physician, and will be determined by your choice of silicone or saline implants, the size of the implants, and other individual issues. Please remember to choose a board certified plastic surgeon when you consult a physician regarding your breast augmentation.