When it comes to choosing incisions for breast augmentation surgery, it is important to consider your options. There is no magical way to insert implants without making some type of incision. The first decision point is whether the procedure is a stand-alone breast augmentation, or a breast augmentation combined with a breast lift.
Let’s start with just a straight breast augmentation. There are three common incisions and a fourth that is mentioned only to be condemned. The most common incisions for breast augmentation surgery are the inframammary crease incision at the base of the breast, the periareolar incision at the junction of the pigmented areolar skin and the native breast skin and lastly, the trans-axillary incision which is made in the underarm area. The umbilical incision has been used to introduce saline implants through a long metal tube into the submuscular pocket. Using the umbilical incision, being limited to traditional saline implants, and the blind dissection technique has led to this procedure being largely abandoned by board-certified plastic surgeons.
At Restore SD Plastic Surgery, we prefer the inframammary crease incision. This incision is remote from the nipple/areolar complex and, therefore, is less likely to be contaminated from normal skin bacteria living in the nipple or subcutaneous milk ducts. These bacteria are harmless in and of themselves but have been thought to play a role in the development of capsular contracture. The inframammary crease incision allows the most direct access to the submuscular or subglandular plane and avoids dissection through the milk ducts around the nipple. Additionally, the inframammary crease incision is often required to optimize the results of breast implant revision surgery. Our thought is to just use one incision for the primary surgery and have that be the best option for subsequent operations as well. Breast implants are not lifetime devices and you will be back in the operating room for an implant related surgery at some point in your life.
The periareolar incision is another common incision for cosmetic surgery. Women have a wide range of areolar size which can play a part in the decision of what incision is best for an individual patient. For example, a silicone gel implant requires an incision of 4-5 cm while a saline implant can be placed through a slightly smaller incision. A woman with a small diameter areola may not be able to accommodate a 4-5 cm incision for placement of a gel implant and would need an inframammary crease or trans-axillary incision. As mentioned above, the periareolar incision may be associated with a slightly higher rate of capsular contracture. The advantage of this incision is that it is placed at the border of pigmented and non-pigmented skin and is nicely camouflaged.
The trans-axillary incision is used by some surgeons for primary breast augmentation but has limited use in revision surgery. A 4-5 cm incision in a natural skin crease in the underarm area is used to create a submuscular pocket for implant placement. This technique can lead to the implants appearing a little high because it is hard to reach the lower aspect of the dissection zone without very specialized instrumentation. The trans-axillary incision avoids placing a scar on the breast but does leave a noticeable scar in the underarm area. In cooler climates, this is not a big deal, but in warmer climates where tank tops, sleeveless blouses, and bathing suits are worn more frequently, the scar can be noticed when raising the arm in the air.
When choosing to undergo a breast augmentation, it is important to partner with your surgeon and discuss everything from implant sizes to incision locations. Always see a board-certified plastic surgeon in your area who has extensive experience in cosmetic breast surgery and is a member of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery. Both of these professional organizations have “find a surgeon” features on their websites to help you locate a qualified plastic surgeon near you. Spend a few minutes checking out your surgeon’s credentials before you spend a lifetime looking at their results. Many people are surprised to realize that many “cosmetic surgeons” not only are not real plastic surgeons but are not board-certified surgeons of any kind.
At Restore SD Plastic Surgery, our board-certified surgeons, Dr. Trent Douglas and Dr. Katerina Gallus, each have over 12 years of experience in cosmetic breast augmentation surgery and will help guide you to results that reflect your goals. We only operate in accredited facilities and are committed to the utmost in ethical standards and patient safety. When you are ready for one of the best breast augmentation experiences in San Diego, look no further than Restore SD Plastic Surgery. Call us at 858-239-2486 to book your complimentary consultation!