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Breast Augmentation Techniques: Placing Breast Implants Using Different Incisions and Incision Sites
Breast augmentation is one of the most popular plastic surgery procedures today. To meet the various needs of women seeking to undergo the procedure, several different techniques for breast implant placement have developed. The different techniques for placing breast implants vary as to the types of incisions used as well as the incision sites. The following is an overview of the most commonly used breast augmentation techniques.

Breast Implant Incision Sites
One of the top priorities for both patient and surgeon is the discreet placement of each incision during breast augmentation surgery. Although scars fade significantly with time, they never completely disappear, so making the incisions in an inconspicuous location can enhance the overall results of surgery. When placing breast implants, the four most commonly used incision sites are the crease beneath the breast, the armpit, the areola, and the navel. Nipple and crease incisions are the most popular breast implant incision methods, although the transaxillary and T.U.B.A. incisions are gaining popularity. Determining the location of incision placement is done on a case-by-case basis, taking into consideration the patient’s wishes and individual anatomy.

There are pros and cons to each of the techniques for placing breast implants, and a majority of cosmetic surgeons favor a particular incision site. If you have a preference for a certain type of breast augmentation incision, you should try to find a surgeon who is experienced in using that method. Most surgeons are skilled at placing breast implants via the inframammary crease or areola. If you are interested in the T.U.B.A. or transaxillary incision techniques, you will need to find a qualified surgeon who is experienced in these methods of incision.

Breast augmentation incisions for pre-filled saline breast implants or silicone gel breast implants are usually a little longer than incisions made to accommodate inflatable saline implants. Depending on the size of the breast implant being used, however, an experienced surgeon may be able to place a pre-filled breast implant through a fairly small incision. A longer incision is required for the insertion of a textured, pre-filled breast implant due to the rough nature of the implant shell and the difficulty of manipulating the implant through the incision. Smaller incisions are used for inflatable saline breast implants because these types of implants are rolled up and inserted before they are filled with a safe saline solution. Inflatable saline breast implants can be placed via any type of incision.

Inframammary (Crease) Breast Implant Incisions
The inframammary, or crease, incision is probably the most common breast augmentation incision used today. This incision site allows the implant to be placed over, partially under, or completely under the chest wall muscle. The inframammary incision also allows the plastic surgeon to work within close proximity of the breast for more control over the placement of the breast implant.

With an inframammary incision, the resulting scar should be visible only when you are in a horizontal position. The surgeon usually tries to situate the incision so that it will fall just above the inframammary fold to prevent the scar from being seen. The surgeon must properly evaluate where the incision will be in relation to your new breast size. If the incision is made too high or too low, the scars could be very visible.

One distinct advantage of this type of breast augmentation incision is that it allows a surgeon to perform virtually all revisions, such as those for capsular contracture, symmastia, and bottoming out, without having to make an incision elsewhere on the breast. Certain other incision methods do not allow surgeons to use the original incision site for revision surgery; an additional incision has to be made, which produces further scarring.

A disadvantage of an inframammary incision is that the cosmetic surgeon has to guess as to where to place it on the breast. While this typically isn’t a problem for an experienced surgeon, it can be difficult to do when there is little breast tissue or little or no natural crease. Also, if you choose later to have additional breast augmentation surgery, the results may be less than ideal. If you decide you want much larger breast implants, your creases will have to be lowered. Going with a larger breast implant size may mean that the incision scars from your previous surgery will ride higher on your breasts. The opposite effect will occur if you select smaller breast implants: your breast creases will have to be raised, meaning the incision scars will be lower than where they were intended to be. If, for any reason, you decide to have your breast implants permanently removed, the scars will no longer sit undetected in the inframammary folds.

Areola (Nipple) Breast Implant Incisions
Along with the inframammary incision, the nipple incision technique is currently one of the most widely used methods for placing breast implants. If a patient’s implants should ever need to be removed, the operation could be done via this incision site. Similar to the crease incision, an areola incision allows the surgeon to work close to the breast, instead of farther away, as with a transaxillary or T.U.B.A. incision.

In this technique, an incision is made at the edge of the areola – the pigmented area of skin that surrounds the nipple. The incision is made on the edge, where the lighter breast tissue meets the darker tissue, so that the scar will blend in. When properly performed, an areola incision leaves a small scar that heals nicely. If the scars do not heal properly, however, they may be very noticeable, since they are situated right in the center of the breasts. Protective "sleeves" are utilized when inserting the breast implants through the nipple incision site in order to protect the breast ducts. Complications, such as the harboring of bacteria, can arise if the breast implant comes into contact with these ducts.

Patients who wish to undergo mastopexy, or breast lift, in conjunction with breast augmentation will likely be recommended the areola (nipple) breast incision site by their surgeon, since both of these procedures can be performed with this type of incision. Using an alternative incision technique would be unfavorable, as it would produce additional, unnecessary scars.

Apart from the potential for noticeable scars in the center of the breast, another disadvantage of the areola breast implant incision is that when placing the implant in the partial or complete sub-muscular position, the muscles and connective tissue must be separated. This trauma results in heightened post-operative discomfort. A vast majority of women who choose areola breast implant incisions are very happy with their results, however.

Transaxillary (Armpit) Breast Implant Incisions
The transaxillary incision leaves a scarless breast after breast augmentation. The site for this particular method is the armpit. Since the armpit normally remains concealed, scars resulting from transaxillary breast augmentation are highly inconspicuous, even if they do not heal properly. The transaxillary incision (like the T.U.B.A. approach) requires the surgeon to work farther away from the breast, making this method more difficult than the inframammary and areola incision methods. As a result, if you are considering an armpit incision, finding a surgeon who is skilled and experienced in this type of technique is a must.

An endoscope may be employed for transaxillary breast implant placement. An endoscope is a thin, flexible tube with a small, surgical camera at the end. Once the armpit incision has been made, a channel is made to the breast. Through this channel, the breast implant is inserted and then worked into place. Armpit incisions allow implants to be placed above or below the chest muscle.

The principal disadvantage of transaxillary incision is that, in the event of a complication that requires follow-up surgery, a different incision will likely be required, which will cause additional scarring. Another drawback of this method is that it cannot be used for the placement of silicone gel breast implants.

T.U.B.A. (Navel) Breast Implant Incisions
A revolutionary development in breast implant incisions, the T.U.B.A. (Trans-umbilical breast augmentation) method allows implants to be placed above or below the pectoral muscles. Since it is a relatively new technique, only a few surgeons are qualified to perform it.

In trans-umbilical breast augmentation, the incision is made along the rim of the patient’s navel. An endoscope is then tunneled to the breast and a pocket for the implant is formed behind the breast. The breast implant is inserted through the incision and moved into the breast pocket. Once inside the pocket, the implant is filled with a pre-determined amount of sterile saline solution. When the desired look is achieved, the filling tube and endoscope are removed.

The breast implant incision scar resulting from T.U.B.A. is very small and virtually undetectable. Abdominal skin typically has more elasticity than the skin on other incision sites. This allows for a smaller surgical scar once the procedure is completed. One of the disadvantages of T.U.B.A., however, is that the endoscope can create tracks (permanent marks) from pushing up from beneath the abdominal skin. This type of complication is rare, though.

Some surgeons have reported that trans-umbilical breast augmentation involves a shorter recovery period and less postoperative discomfort than other types of breast augmentation.

Breast Implant Placement
There are two possible locations for breast implant placement: directly behind the breast tissue (subglandular placement) or under the pectoral muscle (submuscular placement). Some surgeons recommend placing the breast implant in front of the chest muscle because this method tends to reduce postoperative pain and soreness. Others advocate placing the breast implant behind the pectoral muscle in order to prevent interference with mammograms. In addition, one of the most common complications of breast augmentation surgery, capsular contracture, is less likely with placement behind the pectoral muscle. Capsular contracture occurs when scar tissue puts excessive pressure on the implant, causing it to become inflexible and/or uncomfortable. Treatment for capsular contracture often involves surgery either to remove the scar tissue or replace the breast implant.

Submuscular Breast Implant Placement
Complete submuscular placement can be achieved via the transaxillary, periareolar, or inframammary breast augmentation incisions.

Pros:

The breast implant is fully covered by the breast tissue and muscle, which helps to conceal the edges and ripples of the breast implant.
Submuscular implant placement does not interfere with mammography exams.
There is a lower risk of capsular contracture.
Submuscular breast implant placement lowers the possibility of "bottoming out." Breast implants can end up too low on the chest wall, which causes the nipples to end up positioned too high on the breasts.
Cons:

There is more post-operative discomfort.
Re-operation is more difficult.
Submuscular breast implants require longer recovery time.
The breast implant surgery may be longer.
Subglandular Breast Implant Placement
Subglandular placement involves inserting the breast implant between the pectoral muscle and the mammary gland.

Pros:

The breast implants are very easy to place.
There is typically less recovery time.
Subglandular breast implant placement patients often have less postoperative pain and discomfort. The muscles are left in tact, and only skin and fat are cut.
Cleavage is more easily created, particularly if the breasts are naturally spaced wide apart.
Provides easier access for re-operation.
Cons:

Ripples in the breasts caused by the implants are more easily seen and felt, especially in women with little or no breast tissue.
Imaging during a mammography exam is more difficult.
Capsule contracture rates are highest in women with breast implants placed over the pectoral muscle.
There tends to be more pronounced "roundness" in subglandular breast implants. Implants placed under the muscle tend to have a more natural slope.
No single placement technique or breast implant incision site is right for everyone. Talk your cosmetic surgeon for more information about which methods are best suited to meet your unique needs.

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Carissa21674 · Posted: Sat Dec 30, 2006 11:53 am Post subject:

My ps tends to favor the Trans ax incision. This incision allows for scarless breasts. Unfortunately, I wasnt a candidate for this incision since I needed a lift. Thankfully, I'm fair skinned and my scars healed wonderfully :)