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Breast Augmentation: 4 Incision Options

Sep 1, 2007
Breast augmentation is one of the most common cosmetic operations performed today. There are many reasons a woman would seek out breast augmentation. Some women who seek breast augmentation have small breasts and want to balance out their figures.

Others have lost breast tissue simply through aging or childbirth, and some would like to correct breast asymmetry which may be congenital. In some cases if a woman has lost a lot of breast tissue and does not like the appearance of her breasts she may require a lift in addition to breast implants.

Implants can be placed above or below the muscle. I believe this is the most important decision. The best place for the implant will be decided by you and your physician and will depend upon several factors: the appearance of your breasts at the time of the consultation, the size of the implant to be used and desired/expected result.

Generally speaking, when the implant is placed above the muscle, recovery time will be slightly less than when placed below the muscle.

There are four possible incisions that can be used to put the implants in the pocket selected:

1. Peri-Areolar: Through an incision around the areola (outside edge of your nipple),
2. Inframammary: In the fold under the breast tissue,
3. Transaxillary: Through the axilla/armpit,
4. Trans-Umbilical: Through the belly button.

When I place implants in through the belly button or armpit I use and endoscope which gives me precise placement by allowing me to view the area on a video screen while I'm working. This makes the actual procedure quicker and patients have little or no bruising after the surgery. The recovery time is also decreased when I use an endoscope as there is no ripping and tearing of muscle and tissue.

Peri-areolar Approach:

The incision is usually made around the inferior or lower part of the areola skin where it joins with breast skin. Implants can be placed in a pocket above or below the muscle. When this incision heals well there will be a fine white line that is hard to detect upon exam. There is no increased loss of sensation to the nipple when using this approach. This incision is always hidden unless you show someone.

Inframammary Approach:

The incision is placed either in the fold under the breast or just above the fold. The implant can be placed in a pocket above or below the muscle. This incision gives the best access to the breast tissue and is used necessarily in cases of congenital or developmental deformity. When it heals well this incision will be a fine line that is hard to detect upon examination of the breast. This incision is always hidden unless you show someone.

Trans-Axillary Approcah:

This approach uses a pre-existing crease in the armpit. The implant is placed in a sub-muscular pocket most often with this approach. This approach has been around a long time but has been revolutionized with the use of an endoscope.

The endoscope provides for visualization of the sub-muscular pocket allowing for exact placement of the implant with little or no bruising in ninety percent of the cases. When the incision heals it is virtually invisible. There is no increase in infection with this approach.

Trans-Umbilical Approach:

This is also referred to as the TUBA procedure. TUBA stands for trans-umbilical breast augmentation. This technique has been slow to catch on but in the right patient works well. The implants can be placed either under the muscle or over the muscle.

The implant mal-position rate in the sub-muscular pocket approaches 15%. I prefer to go above the muscle when using this technique. Recovery is quick and in most cases there is very little bruising.

Breast augmentation is ideally done under general anesthesia. It can be done under local anesthesia but the procedure takes longer and there is an increased risk of bleeding complications. The procedure takes anywhere from 30 minutes to one hour to perform. Implants placed in the sub-muscular pocket will ride high for two to four weeks.

Most patients who have the procedure done on a Thursday can return to work by Monday or Tuesday of the following week. They will most likely be sore and tired but still able to perform normal duties. The implants will feel firm for a couple of months following the procedure and you should see your final result at about three months.

Size can be tricky for patients to understand and figure out. Implants don't come in cup sizes but rather in different volumes or cc's. If two friends receive the same size implants but start out with different amounts of breast tissue, they are going to end up different sizes. We approach this issue by measuring the width of the breast and choosing an implant of similar diameter.

We then have the patient try on sizing implants to get an idea about size and volume. This is only a rough estimate but helps the patient to translate volume into size. We also offer photography services during the sizing appointment so patients may take home their possible "after" photos to see what size they like best.
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