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Are you thinking about getting a breast augmentation? You’re not alone!
Over ten million cosmetic procedures were performed last year, and the number one procedure continues to be breast augmentation surgery. The technology for breast surgery has improved in leaps and bounds in recent years, and with each new advancement comes more choices. Lots more choices!
One of the most important decisions you’ll have to make is what kind of incision your doctor will make when they insert your implants. This is almost as big of a decision as choosing the size and style of your implants, since your scar placement can change the aesthetics of your overall result.
Not sure which type of incision is best for you? Keep reading to learn about the pros and cons of all four incision decisions!
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Periareolar Incision
This is also called a nipple incision.
The periareolar incision is placed at the edge of your areola, where it meets the lighter part of your breast skin. It is generally placed around the lower half and then the implant is inserted behind the breast tissue or underneath the pectoral muscle, depending on what you and your doctor have decided.
Pros: Periareolar incisions tend to heal quite well, and, because of their placement, the scar they create can blend nicely into the line between the areola and the rest of the breast. Their placement means that they won’t show under even a very low-cut top. Another bonus is that if your implants need adjusting or fixing later on, your surgeon will probably be able to reuse the same entry point. That means no extra scars in the future.
Cons: When a periareolar incision is made, it severs some of the milk ducts and nerves in the nipple, which can affect a woman’s ability to breastfeed, as well as reduce nipple sensitivity. There are also bacteria in the nipple area that can cause infections after surgery. Also, if the incisions don’t heal as well as they should the scar might end up a shade or two lighter than the rest of your areola, or it may be slightly raised. That could potentially mean that it could be visible through a bathing suit or a tight shirt.
Inframammary Incisions
Commonly called a crease incision.
The inframammary incision is made in the natural fold underneath the breast or in the location where that fold will be after the implants are in place.
Pros: Because of its proximity to the breast, an inframammary incision makes it easy for your doctor to control the exact placement of your implant. It does not disrupt the breast tissue, so the breast’s functions (like breastfeeding and nipple sensitivity) remain unaffected. The incision location can probably be reused in the case of revision surgery further down the line. Its location underneath the breast means it probably will not be visible, even under bathing suits or lingerie.
Cons: If you want to change the size of your implants in the future, the crease underneath your breast might have to be lowered or raised. This may make the scar from your first surgery more visible than you might want it to be.
Transaxillary Incisions
A transaxillary incision is made near the apex of the armpit (axillary area), in it’s natural crease. Some surgeons use an endoscope (a tiny surgical camera) to help place the implant once the incision is made, but this is traditionally done as a blind approach, mostly by feel.
Pros: The biggest draw of the transaxillary incision is that fact that the scar it creates is not on or near the breast. This is often popular with women who wish to hide their implant scars as much as possible.
Cons: While there won’t be a visible scar on your breast, there will be a visible scar in your armpit. This can potentially interfere with the removal of under-arm hair (especially shaving). The incision can also cause numbness in the inner area of your upper arms.
Your surgeon may also have some difficulty being precise when placing your implant, since the incision isn’t very close to the breast. It’s important to find a doctor experienced with the transaxillary approach so that you reduce this risk as much as possible. It is also not the best choice if your breasts are uneven to start out or if you are very tall or have a long torso. This incision is a one-time deal. If you want revision surgery in the future, it can’t be reused. You will need another incision.
Transumbilical Incisions
This is the newest incision option of the four.
A transumbilical (or TUBA) incision is made in the upper border of your belly button. The implants are inserted through the abdominal area, moved up through the navel to the breasts, and then inflated. Like a transaxillary incision, this can be performed with or without an endoscope.
Pros: Since the TUBA incision is made in the belly button, there is no visible scarring whatsoever. Patients usually experience shorter recovery with TUBA incisions than they do with the other three options.
Cons: Like the transaxillary approach, the TUBA incision’s remoteness from the breast can make placing the implants difficult. Not many doctors have mastery of this approach since it’s relatively new, and if complications like bleeding arise, or if your surgeon is having trouble visualizing the procedure, they may have to abandon the method and make an inframammary incision mid-surgery.
If you want silicone implants, this incision is not an option! Only saline implants can be used because they have to be rolled up tightly before being placed, and are only inflated once they are in the breasts.
One last disadvantage: like the transaxillary incision, the TUBA incision is a one-shot approach. If you want another breast surgery later on, you’ll have to use one of the other incision methods. That is an important fact to consider since this method is more likely than a direct approach to have a higher chance for malposition of the implant.
There’s really no such thing as one right choice when it comes to getting breast implants, there is only the best choice for yourself. Your decision will depend on your implant type and size, your doctor’s experience, the shape of your breasts, and even your lifestyle. Know the facts and know your plastic surgeon to make your incision an easy decision!
Additional Resources
- http://www.nlm.nih.gov/medlineplus/ency/article/002984.htm
- http://www.realself.com/question/options-alternatives-breast-implants-incisions
Usha Rajagopal, MD
San Francisco Plastic Surgery & Laser Center
http://www.sfcosmeticsurgery.com
info@sfcosmeticsurgery.com
Breast Augmentation New York | Breast Implants | Breast Implant Specialist | Plastic Surgery 
Breast implants can be put in through multiple incision approaches as you know. The incision is not the important part of the breast augmentation operation, the breast implant is….anyway it’s a great post…
I agree that it is a good post, but you have to take step one first – decide if this implant is going behind or in front of the muscle. If it is going behind the muscle, a Periareolar/nipple incision is possible, but you have to have a really experienced surgeon for a good short-term outcome. An uneven appearance is quite common in the short-term with this incision/placement combination.
Choosing the type of incision is really important. Much will depend on it. Anyhow this is a very helpful post for women who have decided to change their appearance and their life as well.