Northern Virginia Breast Augmentation Incisions

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Northern VA Breast Augmentation Incisions & Scars

Many choices need to be made when having breast augmentation. What size implants? Saline or silicone? Tear-drop or round? Textured or smooth? The choice of where the incision should be made is just one of the many decisions. You’ll receive guidance from the plastic surgeon on most of these issues. This is very true for the incision choice; the plastic surgeon will give you guidance on the best option. Many times it comes down to your body and your goals. These things must be considered:

  • Your body type.
  • Your goals.
  • Whether you plan to breastfeed.
  • The size and type of implants you will have.
  • The safety of the incision method.
  • How much control is afforded by the incision option?
  • The appearance of the scar.

breast augmentation incisionsWhen it comes to the location of the incision, there are 4 general options:

  • Under the armpit. This is called a Transaxillary incision.
  • Around the edge of the nipple. This is called a Areolar or Periareolar incision.
  • At the crease at the bottom of the breast. This is called an Inframammary incision.
  • Through the belly button. This is called a Transumbilical or TUBA incision.

There’s no perfect answer across the board. There are pros and cons to each choice. Reviewing these will help make the decision clearer for your situation.

Pros and Cons of the different Breast Augmentation Incisions

Areolar Incision or Periareolar Incision for Breast Augmentation

This method uses an incision that goes around a portion of the nipple (usually the lower half). This is used as the entry point to insert the breast implant.

Pros:

  • The breast incision is made where the darker areola meets the surrounding skin. This means the scar often blends into the nearby tissue. Even though the scar is on the visible of the breast, it still won’t show when cleavage is showing.
  • This incision option can be used again if later surgeries are needed.
  • With direct vision, the plastic surgeon can accurately create space for the implant.

Cons:

  • The incidence of infection after breast implant surgery may be greater. This is because types of bacteria are present in the breast ducts. (The surgeon must go through the breast ducts).
  • By going through the nipple, the surgeon must cut through some of the breast milk ducts to place the implant. This might interfere with breastfeeding in the future.
  • One of the possible problems after breast augmentation is a change in nipple sensitivity. This is more common when using this type of incision.(The change may be temporary, however)
  • While the scar can blend in at the edge of the areola, there is also a chance it could be visible, or a different color than the nearby tissue. It could also be raised and be visible through some types of clothes.
  • The scar can retract into the breast tissue and distort the nipple, or areolae, or breast or all of the above.
  • If this incision is used a second time, the incidence of scar and breast deformity increases.
  • This scar can easily become darker in women of color, which can be very concerning.
  • If the areola is too small, this is not a good option. Especially will silicone gel implants.
Areolar incisions with visible scars & distortion

Areolar incisions with visible scars & distortion*

Inframammary Incision or Breast Crease Incision for Breast Augmentation

This incision is placed at the bottom of the breast near the crease. (This is called the inframammary fold). It may be referred to as a crease incision. This is the most commonly-used incision today.

Pros:

  • This incision option gives the experienced plastic surgeon the most control over the exact placement of the breast implant. This is especially important for those who are changing the breast shape at the same time as increasing the breast size.
  • It allows the pockets for the implants to be created and compared before placing the implant. This means the results are more likely to be consistent and symmetric.
  • Unlike the nipple incision, the breast glands are not cut. This means there will not be any problems with breastfeeding. This also means there is less trauma to the breast tissue.
  • Like the nipple incision, this incision point can be used again in case of future surgeries.
  • In secondary surgeries, this incision allows for the most control over changing the pocket size or corrections.
  • The scar when using a saline implant is quite small since the implant is inserted empty. It is typically 3 cm long. The incision length will be a bit longer when using silicone implants. While it is a visible scar, the position underneath the breast in the fold means it is not visible while standing topless.

Cons:

  • While usually hidden, the scar can be visible on the breast when lying down and looked for.
pictures of breast augmentation inframammary scars

pictures of breast augmentation inframammary scars*

Transaxillary Incision for Breast Augmentation

This incision is made in the crease of the armpit. The breast implant is then inserted from that point. This is done using special tools to do the procedure from a distance. Some surgeons use a camera to assist in creating the space for the implant. Others go by feel. This is called a blind approach.

Pros:

  • There is no scar on the breast itself.
  • Despite the fact that the incision is not directly on the breast, either saline or silicone implants can be used.
  • When used with a camera, it is a safe procedure.

Cons:

  • If a camera is not used, the incision is small but there is no visualization of the surgical pocket. This is a blind technique and results in less control.
  • The plastic surgeon can not feel the tissues to determine tissue quality.
  • Since the breast implant must be placed without direct access to the breast, this option is less precise. This may result in an increased risk in implant asymmetry after the surgery.
  • This technique is done one side, then the other. Adjustments after implant placement increases complications.
  • This method has been associated with an increased chance of bleeding after augmentation.
  • If there are complications during the procedure, incisions may have to be made on the breast anyway.
  • The armpit scar can be a problem when shaving.
  • Though either saline or silicone implants can be used with this method, larger silicone implants may not work well with this choice.
  • The armpit scar will be visible when wearing sleeveless shirts. It may even be more distinct than the other scars would be.
  • The incision can make the surrounding tissue permanently numb under the arm.
  • This entry point cannot be reused after the tissue has healed. If a new surgery is needed in the future, that will mean a second scar.
  • The secondary incision is usually under the breast.
Transaxillary incision without camera assistance

Transaxillary incision without camera assistance*

Transumbilical or TUBA for Breast Augmentation

Often called the scar-less option, this incision is actually within the belly button. However, there are many drawbacks and most surgeons do not recommend this approach. For those who use it, the implants are inserted at the incision in the belly button. They are moved upward into position using a long metallic tube. Like the placement via the armpit, some surgeons use a camera to assist and some do not.

Pros:

  • No visible scar at all in many cases. The only resulting scar is usually hidden within the folds of the belly button.

Cons:

  • There is no visualization of the surgical area. It is a blind procedure.
  • The plastic surgeon can not feel the tissues to determine tissue quality.
  • The tools used can carry additional risks; for example, other organs can be injured when the tube is inserted. For this reason alone, many surgeons will not use this method.
  • Saline implants are the only option for this incision choice; they only work because they are inserted empty and filled once in place. Silicone implants are pre-filled, making them too large for this option.
  • While the incision usually creates only a hidden scar, it could in fact be visible and quite noticeable.
  • For some, the tracks where the tubes were used to push the implant up to the breast are still visible after surgery.
  • Placing the implants correctly can be difficult. This is because the incision point is so far from the breast. Like the armpit incision, this means there is a higher risk that the breast implants will not be placed correctly. There is also a higher risk that the cleavage will have a wide gap.
  • As with the armpit incision, if there are complications during the procedure, incisions may have to be made on the breast anyway.
  • If additional procedures are required during or after the breast augmentation (such as a breast lift), new incisions will be needed. In fact, if any future breast surgeries are needed, a new incision must be used. This will mean a new (now visible) scar.
  • This option is much more difficult to perform.
  • This technique requires additional consent forms and medical releases because of complication rates.
TUBA approach complication with poorly positioned implants

TUBA approach complication with poorly positioned implants*