Me and my husband are arguing about haveing the transaxillary incision. I'd rather do the Periareolar one. Which is best?
Transaxillary vs. Periareolar Breast Augmentation
Doctor Answers (31)
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Best Incision for Breast Augmentation
There are 3 typically used incisions for breast augmentation, the transaxillary, periariolar and inframammary. Here is the truth about each. First, the transaxillary incision moves the incision from the breast to the armpit. It is technically more difficult to create the pocket and leaves a visible scar if the patient raises her arms wearing a sleeveless shirt or dress. The advantages are... Okay, I don't see any. Especially in darker skinned women where the scar will end up darker than the surrounding skin.
The periariolar incision is the most camouflaged. I use this if I'm doing a breast lift. However, it's a one time incision. Studies have shown that if the implants need to be replaced and the periareolar incision is used a different plane is often used. This compromises the blood supply to the skin. In addition the scarring of the breast may be interpreted poorly on a mammogram creating concern and the need for further study.
I place the incision 1cm below the inframammary fold (breast crease). Using this incision the duel plane can be directly dissected without injury to the breast tissue and after placement of the implant the scar ends up exactly in the fold. No one ever sees the scar.
My wife and I disagree on the incision!!??
you are not having the surgery. it is not on your body and you are crazy to do anything other than support her decision. if there is a sound medical reason to do one incision over the other then it is between your wife and her surgeon. so sit in the corner and nod.
Compromise - use the Inframammary Incision!
This is compromise at it's best: neither of you get your first choice, but your wife ends up with a great - arguably the greatest incision.
Most patients and plastic surgeons sophomorically focus on the location of the scar as the most important issue in deciding on the incision. In fact, the scar is the least important distinction between the incisions.
Why? Because any of three locations almost always gives a good scar. When it doesn't, it is usually related to patient biology, such that someone who gets a bad scar in one location would get it in another. If any incision always gave a perfect scar, we'd all use it. And if any always gave a bad scar, no one would use it.
The transaxillary incision fundamentally doesn't makes sense to me personally: it is the only incision that is visible when fully dressed; when a revision needs to be done, it almost invariably requires another incision; you can lose sensation in the armpit making shaving difficult; unless done endoscopically, it is less accurate and typically more painful and bruised than other approaches; if done endoscopically, it takes much longer in surgery.
The periareolar yields a scar that is visible when the breast is viewed head on; the size of the areola can limit the size of the implant; the size of the areola and the amount of breast tissue limits the visualization and thereby accuracy and bloodlessness of the pocket dissection; and most important of all, dragging an implant through the breast contaminates the implant with the bacteria in the breast, the very bacteria implicated in capsular contracture (hardening.) The best study of its kind shows a statistically significant higher rate of capsular contracture with the periareolar incision than the inframammary incision.
The inframammary incision is hidden in the crease under the breast; it has the least swelling of hte breast since the breast gland itself isn't cut; it is an incision that can be used for any type of revision necessary in the future; it allows for complete and total visualization of the surgery; it allows all implant types to be placed with a minimum of trauma. And once augmented, the scar is up and under the breast, right at the crease where the breast meets the chest wall, an area that frequently has a bra mark that is even more visible than the scar itself.
My suggestion: go inframammary. From your relationship's point of view neither of you lose the argument. And from a medical point of view your wife gets what is to me the most reasonable incision choice.
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Transaxillary vs periareolar vs crease breast augmentation incisions
The transaxillary incision is much less commonly used than it was several years ago. I have treated several patients from my area with misplaced implants through the armpit and even two whose doctors burned through the skin in the lower inner corner of the breast getting lost in where they were in the pocket dissection. Some revisions cannot be done through the armpit so another incision is needed. Finally, the numbness in the upper inner arm that can occur has made this less popular.
The areolar incision is nice but is sometimes limited in that some areolae are not big enough to place a desired silicone gel implant in through without damaging the integrity of the implant. A periareolar (around the entire areola) incision allows for larger implant insertion plus a modest breast lift.
Finally, the crease is a workhorse incision in this as any size implant can be inserted and all revisions can be done through the crease.
Best incision for breast augmentation
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
Transaxillary vs Periareolar Incision for Breast Augmentation
Transaxillary vs periareolar breast augmentation
It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.
Consult with a plastic surgeon your goals, concerns, and expectations. Certainly incisions should be considered, but should not limit your overall result by hindering visualization and access to your surgeon, and what produces the best results in his/her hands. The transaxillary incision is much less used today due to its blind approach and inability to shape the breast pocket as precisely as with the inframammary or even periareolar incision. Especially if you are in need of a breast lift, the periareolar incision may be the better option in this case.
Hope that this helps! Best of luck on your decision and for a great result!
There is no reason to argue about the best incision...
Breast augmentation can be performed utilizing either the inframammary, periareolar or transaxillary approach with either silicone or saline implants. There are pros and cons to any of the incision choices depending on each patient's unique situations. It is best to visit a plastic surgeon who is comfortable with all three approaches to help guide you in your choices for a great breast augmentation result.
Choosing the "best" incision for your breast augmentation
Choosing the best incision for breast augmentation
There are basically four choices of incision for placing breast implants - Inframammary, per-areaolar, transaxillary and trans-umbilical. Choosing the incision for placement of the implants which is best in any given situation can be affected by many factors – these can be broken down into patient specific factors and surgeon specific factors.
Patient specific factors include ethnicity and tendency for poor scarring (some ethnic groups have a propensity for hypertophic or even keloid scarring), pre-existing anatomy (e.g. Is a given patient’s areolae large enough for placement of a pre-filled silicone implant?)
Surgeon specific factors tend to include the biases and experience of the surgeon, which should not be discounted or taken lightly.
My personal experience after over 3000 breast augmentation is that inframammary and peri-areolar incision give the most control over the breast implant pocket and that transaxillary and trans-umbilical incision have a higher revision rate.
You are in a sticky place my friend...it is her body and she obviously has her reasons for wanting that incision--but I am sure that you have done a fair amount of research yourself. I would recommend meeting with your surgeon again and reviewing the pros and cons of each incision and also ask if your surgeon has a preference based on her anatomy. If you want to take it one step further, you may ask your surgeon if this patient was his spouse (this will only work if your surgeon is a male, by the way) where would he put the incisions.
Ultimately, it is up to her however, there are certainly benefits and risks to all surgery. Just make sure she's choosing the right incision for the right reasons. Good Luck.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.