Which incision is the best for breast augmentation surgery?

New data presented at the 2013 American Society for Plastic Surgeons (ASPS) meeting suggests that the inframammary incision (in the fold under the breast) carries nearly a 50% lower risk of capsular contracture than the other incisions (periareolar, transaxillary, and transumbilical).

The overall risk of capsular contracture after breast augmentation surgery is a range of about 10-15%, but new data suggests that the risk can be cut to about 5% with inframammary incisions.

Continue reading to learn more about incisions for breast augmentation surgery and capsular contracture…

This scar tissue capsule around a breast implant is normally a very soft, supple structure that acts like an internal bra to support your implants from the inside. A capsule is a completely normal part of almost any implant procedure, not just breast implants, but it can become very abnormal in cases where capsular contracture develops. Capsular contracture is a hardening and tightening of the capsule that can distort the shape of the breast and sometimes cause a sensation of tightness or pain.

Capsular contracture most commonly develops 3-4 months after surgery, and can progress very rapidly or very slowly. It can also develop much longer after surgery, even years after, and this delayed presentation is usually associated with some form of trauma to the implant or with the rupture of an old breast implant. This is probably the main reason not to wait until you have a problem with an older breast implant before you have them exchanged. If an older implant ruptures and a contracture develops, the exchange surgery will be much more complicated than if you had exchanged the implants before there was a problem. Most surgeons recommend exchanging saline implants for a new pair around 6-8 years after surgery, and silicone around 10-15 years after.

The first photo below is of a patient who had a near-perfect result at 3 months after silicone breast implants placed through a periareolar incision. The second image shows her one month later with an obvious capsular contracture on her right side. Her implant shifted upwards and took on a more rectangular shape because the capsule contracted and began distorting the appearance. She had an uncomfortable tightness on that side, and ended up needing to have a revisional procedure to remove the contracted capsule so that she could return to the soft, natural look she had before the contracture developed.

Based on the newest research, we now understand that the lowest risk of capsular contracture results from the following combination of surgical choices:

1. An inframammary incision. It has been common knowledge for quite a while that the transumbilical and transaxillary incisions should not be used at all because only saline implants can be inserted through these incisions, and saline implants have a higher risk of contracture to begin with. However, the newest research suggests that even the periareolar incision carries a higher risk of contracture as compared to the inframammary incision, and this has not been known until recently.
2. A silicone implant. Current generation of silicone implants are better than saline in every way, but most importantly, they have a lower risk of contracture compared with saline.
3. A sub muscular pocket. Placing the implant under the muscle appears to lower the risk of capsular contracture slightly, but this statistic isn’t conclusive across all studies.
4. A smooth postoperative recovery period. Almost any postoperative complication such as hematomas, seromas, infections, and the need for early revisional procedures increase the risk of contracture, so be sure to follow your surgeon’s advice and take it easy after surgery.

If you have any questions about capsular contracture or breast augmentation surgery, please feel free to give us a call at 917-703-7069, or send us a message through our website by clicking here.

Nicholas Vendemia, M.D.