Breast Implant Incision Placement

Clinic 360
Breast augmentation is a surgical procedure that typically involves the enlargement of the female breasts, and can also incorporate modifications to their shape and texture.

Breast augmentation normally makes use of one of three types of incisions:

  1. Inframammary
  2. Periareolar
  3.  Transaxillary

You and your surgeon will work together to decide which incision type is most appropriate for your procedure.

Inframammary Incision

An inframammary incision is made below each breast, at the fold where it meets the torso. It is the most popular type of incision as it allows the surgeon maximal precision when positioning the implant. An inframammary incision is generally seen as producing the most symmetrical result. It is also the preferred surgical technique for silicone gel implants, which typically require a longer incision. Furthermore, because the surgeon is able to work a lot closer to the breast cavity, the risk of complications is greatly reduced, such as the potential for infection, since incisions are made away from the milk ducts. Inframammary incisions, compared to periareolar incisions, also lead to fewer breastfeeding complications. Inframammary incisions also offer the greatest level of choice in terms of type and placement of implants, as they can accommodate both silicone and saline implants, as well as subglandular (above the muscle) or submuscular (below the muscle) placement. In cases where implants must be replaced, the same incision may be reused, reducing the chances of additional scarring.

The risk of scarring is the biggest disadvantage of inframammary incisions. While the scar is usually hidden in the breast fold, it may still be visible. In addition, if you should choose to increase the size of your implants at a later date, the scars may move up on the breasts and become more visible.

Periareolar Incision

A periareolar incision is made along the lower border of the areola, which is the darker skin surrounding the nipple. It is the incision most commonly used when combining breast augmentation with breast lift procedures. Because the skin of the areola is thinner than the surrounding skin and contains more blood vessels, it is an incision site preferred for its ability to heal relatively well. Scarring is generally minimal and follows the natural border of the areola, making it virtually invisible. Because a periareolar incision is located so close to the placement area, it offers the surgeon a great deal of control when positioning the implants. Furthermore, the incision can be reused in case implant replacements are necessary.

The biggest disadvantage of a periareolar incision is its proximity to the nipple and milk ducts, leading to a potential loss of sensation to the nipple and increasing the risk of breastfeeding complications. Furthermore, exposing the milk ducts can increase the risk of infection. Rest assured that your surgeon is highly aware of the added risks, and will make every effort to prevent such complications. Another disadvantage of a periareolar incision is that it makes silicone gel implants more difficult to insert, because of the relatively small incision size. Your surgeon may opt for a different type of incision should you choose silicone gel implants. Some women with particularly small areolae are not candidates for this type of incision. Periareolar incisions may also produce a greater incidence of capsular contracture: an immune response to foreign materials that causes collagen fibre capsules to form and squeeze the breast implants.

Transaxillary Incision

Another common incision type used for breast augmentation procedures is a transaxillary incision, which is made under the armpit. It is the incision type most commonly used for saline implants, which are inflated after being positioned in the breast cavity. Your surgeon will be guided by the use of an endoscope, which is a small instrument used for viewing the inside of hollow body cavities. A transaxillary incision offers the surgeon good access to the chest muscle, allowing for both subglandular and submuscular placement. Scars are usually well hidden in the folds of the armpit.

Because transaxillary incisions are located further from the breast cavity, breast augmentations using this type of incision are more technically difficult, and are therefore more likely to produce an asymmetrical result. For this reason, only a skilled, experienced surgeon should perform breast augmentation using transaxillary incisions, in order to ensure optimal results. In addition, while it is possible to insert silicone gel implants using transaxillary incisions, they are not the ideal choice for this type of implant. In cases where implant replacement or revision is necessary, another incision must be made, as the transaxillary incision cannot be reopened. Furthermore, certain types of breasts are not suited to transaxillary incisions. Your surgeon will review your suitability for this type of incision on a case-by-case basis.

Transumbilical Incision

A newer, less common incision type is a transumbilical incision, made in the navel. This type of incision involves tunneling through the skin of the abdomen in order to reach the breast cavity. Scarring and recovery time are usually greatly reduced, but many surgeons are reluctant to use this type of incision because of its difficulty and the greater risk of complications. Moreover, it can only be used for saline implants with submuscular placement, and in case of revision, the incision point cannot be reused. This type of incision is sometimes combined with abdominoplasty (tummy tuck).
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