When it comes to breast augmentation, Nashville-based Maxwell Aesthetics works with women with a diversity of body types, breast sizes, and cosmetic goals. There is also a range motivations that lead women to choose the procedure, from seeking to regain volume lost after childbirth and breastfeeding to wanting an aesthetic change for their silhouette. Whatever the reason and no matter the type, shape, or size of implant, every procedure shares a particular commonality: The implant requires that an incision be made so it can be inserted into a pocket in the chest.
Incision placement is a significant element of any breast augmentation surgery, with the location determined by a number of factors. Anatomy is a major consideration. Everything from chest wall width to the shape of the breast and size of the nipple and areola must be taken into account. Other factors that play a role in deciding incision placement include implant dimensions and filler, as well as patient preference.
No matter the location, an experienced plastic surgeon’s goals are to make the incision only as large as it needs to be to accommodate the implant and to make the end result appear natural. Incisions are also typically sited in areas where they can be camouflaged by existing structures or natural lines on the skin, so as to make them less noticeable when they heal.
To help with a final decision, the surgeon may employ what is known as the High Five™ method, which uses breast width, skin stretchiness, and distance between the nipple and the inframammary fold to calculate the ideal volume of implant and placement of pocket within the chest. This information, in turn, can help determine the recommended incision site.
This list of breast augmentation incisions explains the various options, as well as some reasons they are chosen for particular surgical procedures.
Positioned in the crease below the breast, the inframammary incision is hidden in a natural fold. This is the most commonly chosen incision for breast augmentation surgery because it allows immediate access to the breast for insertion of the implant. The 1- to 2-inch scar—though hidden and easily concealed—can still be visible, particularly when the patient is horizontal, as gravity is not pulling the breast downward and forming the crease.
This incision is made in the line where the areola stops and the regular breast skin begins. Because of the transition from darker tissue to lighter tissue, the region is ideal for disguising the line of a scar. “Periareolar” refers to an incision that encompasses only the curve on the lower half of the areola, as opposed to the entire circle.
Patients may opt for this incision because the scar is minimal and typically well hidden. It also gives the plastic surgeon direct access to the breast, which is a significant benefit when it comes to precision implant placement. For augmentation surgeries paired with a mild to moderate lift, this may be the incision of choice.
Saline implants that are inserted empty and then filled with a sterile solution are not as popular as they used to be, with pre-filled silicone and cohesive gel devices serving as the most commonly chosen options today. In cases where saline implants are used, this incision may be made in the armpit. Its main appeal is the lack of any scar on the breast itself, as well as its avoidance of potential damage to nipple sensation. Its distance from the breast does carry the drawback of less precision when it comes to implant placement, since the plastic surgeon is not inserting the implant directly into the breast tissue, but is using a camera inserted through the incision to navigate.
This incision may also be ideal for women who do not have significant enough breast tissue to form an inframammary crease.
While there is no scarring in the breast crease or on the areola with a transaxillary incision, there will be a mark visible under the arm—though it is easily concealed.
Similar in principle to the transaxillary approach, the transumbilical incision was a choice historically chosen by women who wanted saline implants and to avoid marks on or near the breast mound. The navel is already a scar, so using it as an entry point to insert an implant changed very little about the look of the skin. However, this technique also shared the drawbacks of distance, with the plastic surgeon having to tunnel the implant upward from the belly and into position on the chest without a direct line of sight. Lack of control and a tendency toward complications has caused this technique to become more of a rarity in the plastic surgery world.
Each viable incision site has its own unique advantages. Part of a talented plastic surgeon’s job is in guiding a patient in the selection of which incision will be best for her particular case. Women with small nipples and areolas, for instance, would not be good candidates for the periareolar incision.
Learn more about breast augmentation by contacting the Nashville-based Maxwell Aesthetics online or calling 615.932.7700.