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Pros and Cons of Breast Augmentation Incisions

Aug 31, 2007
Knowing you desire an enlargement is only the beginning of your journey. Among the many things to understand is exactly where the implants should be inserted into your body. There are three common entry points, each with it's own set of advantages and downsides.

Periareolar

The Periareolar incision is located on the nipple itself. It is one of the most common procedures in breast augmentation. If you are interested in a mastopexy (breast lift), this incision is the choice most surgeons will recommend. It works well with every type of implant and for both over and under the muscle implant placement.

The Periareolar incision is made around the bottom half of the dark circle of skin surrounding the nipple. The exact incision line is critical for a satisfactory result. For the scar to blend properly it must occur exactly on the edge where the lighter skin meets the darker skin.

If the incision heals within the areola area, a "smiley face" can occur from the lighter-colored scar tissue. Surgical tape is placed on the incision and should not be moved, as it reduces the effects of gravity pulling on the skin and aids the scar to heal as a flat, very thin line. A properly healed scar from a well-placed periareolar incision is barely visible.

A potential risk factor is the bacteria found in breast ducts, which can spread germs into the area holding the implants. Many surgeons use a protective sleeve to keep the implants from coming in contact with the breast ducts. This sleeve is not useable if the implant chosen is pre-filled, as with certain saline or gel implants, since they cannot be rolled-up and put in place unfilled.

Inframammary Fold

The inframammary incision is as popular as the periareolar. The implant can be placed or removed above or below the muscle. Since the implants do not pass through the breast ducts, the risk of bacterial infection is greatly reduced. This incision is a favorite among surgeons because it gives the surgeon a great deal of control over the placement of the implant.

The incision is made just above the crease, or inframammary fold, underneath the breast. This helps prevent the scar being seen when in a swimsuit or lingerie. Proper placement is an art-form in itself; the surgeon must estimate where the incision will sit in relation to the crease created by the larger, enhanced breast. A wrong placement higher or lower on the breast will make the incision visible.

Along with giving the surgeon control over implant placement, they also favor this incision for it's use in revision work. Should you need a revision, the original location can be revisited. This means no additional scars that an initial transaxillary incision would require and no additional risk of nipple sensitivity that a periareolar could cause.

A downside to this procedure is if you decide to substantially change the size of the implants after surgery. It is not uncommon after the initial implant procedure for a patient to wish she were bigger or smaller. An implant needs to be centered behind the nipple to look natural.

If you decide to go much bigger, the scar will be located higher on the breast. If you go smaller the crease will be raised, exposing the scar in a lower position, possibly in view under a bra or swimsuit.

Transaxillary

The immediate benefit of a transaxillary incision is the lack of scars to the breast. The incision is located in the armpit, where it is only seen when you raise your arm. The scar typically heals well, with maybe a slight discoloration to the skin.

Should your scar be fairly noticeable, it will be located in a place where few people will associate it with breast enlargement. The implant can be placed above or below the muscle with this incision.

Though the entry point is away from the breast itself, the procedure can be achieved with or without an endoscope. It is important that your surgeon is very skilled at this incision. If your surgeon does not use an endoscope, the implant can look lopsided.

The downside to the transaxillary incision is in the event of a complication, you will need another surgery and most likely at a different entry point. The transaxillary incision may not be suitable for certain types of corrective surgery.

As an example, if you suffer from bottoming out, where your nipple appears too high on the breast due to an implant dropping too low on your chest, an incision on or under the breast would be a better choice.

As you can see, careful consideration is necessary to choose which incision is right for you. Once you and your surgeon have decided upon an incision, you are that much closer to changing the way you look.

Since each person's body is a work of art in itself, there is no "one size fits all" to any surgical procedure. It is always best to seek the advice of a trusted, experienced surgeon before settling into any decision.
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