Athens Doctors

My Wife and I Disagree on the Best Incision for Her Breast Augmentation

Me and my wife are arguing about haveing the transaxillary incision. She wants it... I'd rather her do the Periareolar one. Is there anything else I can tell her to change her mind?

There are many great answers and I agree with most of them. Each plastic surgeon has their own philosophy. My best advice is to let your wife and her plastic surgeon decide. This is a big decision and she must consider not only the positives, but also the negatives.

The only advantage to the transaxillary incision is that you don't have a scar on the breast. There are, however, many negative to this approach: (1) a scar in the axilla can be seen when raising the arms, (2) if the scar becomes hypertrophic it may interfere with shaving, (3) the implants have a tendency to ride high because of the dissection during implant placement, (4) it is hard to place large silicone implants through this approach, (5) surgery time (and hence, your cost) tends to be longer, and (6) subsequent surgeries tend to require a second incision. In other words, when it's time to have her implants replaced, it is unlikely that your plastic surgeon with use this approach again - especially if she needs a breast lift or capsulectomy. The result is that now she will have two incisions.

The periareolar incision is a good approach, especially if she need a small lift at the same time. When it heals well it looks great. But there are a few things to consider. This approach puts the incision right on the breast. Therefore, if the incision doesn't heal well (scar hyperthrophy, widening, darkening) she will see this everytime she looks in the mirror. There is also an increased risk of infection. Nevertheless, if your wife has dark, moderately sized areolas, this could be a good approach.

Usually, I recommend the inframammary (under the breast) approach because it is quick, straightforward and the scar is well hidden when looking at the breast straight on. It is also easy to perform a revision through this approach. When I combine this approach with a dual plane breast augmentation (for ladies with some sagging after children) this gives a very nice predictable result.

Hope this helps

Andrew Jimerson, MD

Atlanta Plastic Surgeon

Staging Breast Lift and Augmentation to Avoid Stretched out Areolas?!

As the picture indicates, not only are my breasts sagging from fluctuating weight (which is under control now), but my areolas are the size of hubcaps! I want to get a lift plus and implant to regain my size, but I'm afraid of stretching out my areola because my skin is so loose--even if the circumference is trimmed during surgery. Would I decrease the chance of huge areolas by staging the procedures, getting the lift done first? -34C, never had kids, petite (5'9" 130lbs), super fit, South Asian/Indian

By its very nature, a breast lift is a skin reduction procedure while a breast augmentation adds volume. This increase in volume places tension on the skin and scar. Anytime you place tension on a scar, there is a risk of scar widening.

While I agree with my colleagues that placement of a permanent suture may decrease this risk considerably, scar widening is still something to consider. If you went with the combo procedure of a "donut" lift/augmentation in one stage, going with a smaller implant may decrease your risk of scar widening because it creates less tension.

Personally, if i had a patient who was concerned about periareolar scar widening, I would offer this patient a staged procedure. In the first procedure, I would preform a vertical breast lift and in the second procedure, I would perform the breast augmentation

Hope this helps.

Andrew Jimerson, MD

Atlanta Plastic Surgeon

Care Credit - Breast Implant Financing Options

i talked to a plastic surgeon about financing my breast augmentation surgery. She said that Care Credit charged her exhorbitant fees so she wouldn't take it.  Since getting credit is really hard now days, are doctors more welcoming of Care Credit even if it costs them more? Will doctors make me pay more to use Care Credit?

Just about everyone has felt the pinch of our current economic situation. Plastic surgeons have been hit worse than a lot of other medical specialties because a large portion of our business is cosmetic. Elective plastic surgery is one of the first things many people do without when times are tough.

For that reason, it has actually become even more difficult than usual for surgeons to accept Care Credit. It doesn’t mean we won’t accept it, but it is generally not the most cost-effective option for surgeons or patients. As many of my colleagues have already mentioned, most plastic surgeons offer a discount for cash-paying patients. Paying cash will generally get you the lowest possible rate on your procedure.

Andrew Jimerson, MD

Atlanta Plastic Surgeon