Breast Iimplants & Incision Choices
Which approach is best for me?
The answer to this question is based on a number or variables. You may already have a strong feeling as to where you want the small scar to be placed. I too have a “favorite” incision which we will discuss in this article. I would like to introduce you to the science that should be involved in your decision process. This will also be discussed with you at the time of your personal and complimentary consultation with me.
Anecdotal studies are now finally showing that incisions through the areola and armpit (axillary) have a higher risk of resulting in a capsular contracture. A contracture is where the implants harden due to a rejection process the body mounts against the breast implant. The cause is not fully understood, but may be related to bacteria harboring on the plastic coating of the implant stimulating an inflammatory reaction. Incisions through the armpit and breast tissue itself (periareolar) force the implant to be inserted through these bacteria laden regions. In contrast, the umbilical (belly button) and my favorite, the inframammary (lower fold of the breast), allow the implant to be inserted directly through the skin, where fewer bacteria reside naturally. Thus, there is a lower rate of capsular contracture in augmentations performed through these incisions.
The type of implant chosen also enters the incision decision algarithm. Silicone implants, now the most popular implant choice not only worldwide but also in the USA, require a slightly larger incision because they are prefilled. This makes the umbilical approach very difficult if at all possible. Many women’s areola are too small to make an adequate incision. Therefore, the inframammary approach is generally the placement of choice for silicone. Saline implants, now used less and less frequently, can be placed easily through any incision because they are placed while empty then filled once in place.
Breast anatomy can also be a factor. Women born with tuberous breasts (small breasts with wide areola and a bit saggy) do not have an inframammary fold at the right place for the incision. It is too high. In these cases, the periareolar incision is often used so that an incision does not have to be made on the lower chest skin itself. Many plastic surgeons still prefer inframammary in these cases, it just requires more exact planning to place the incision exactly where the new inframmamary fold will be when the implant is in place. Small breasts, with normal anatomy, may pose the same problem as above, with a fold that is naturally higher than it will be once the implant is in place.
If a simultaneous lift is to be performed, the implant will usually be inserted through the lift incisions so as to not add extra scars.
Finally, in women who are planning on having children, I again prefer the inframmary incision. This incision allows the implant to be placed with absolutely NO disruption of the breast glands and ducts. In this case, your breast implants should have no effect whatsoever on your future breast feeding ability.
I recommend that you schedule a COMPLIMENTARY CONSULTATION so we can discuss your individual situation and preferences. I have performed many breast augmentations through each of the approaches available so we can at least consider and discuss your preferences when it comes to incision placement.
Dr. Marcus is a Board Certified Plastic and Reconstructive Surgeon, specializing in Cosmetic Plastic Surgery at his Cosmetic Surgery & Laser Center located in Santa Rosa, CA. Dr. Marcus was born and raised in Michigan, where he received his highly-regarded surgery and plastic surgery training.