Armpit Incision for Breast Augmentation Because Nipples Are Small?

Implants can be inserted through the belly button, the armpit, the nipple/ areola and through the inframammary crease (the fold below the breast). The location of the scar should be based on several factors. The first consideration is the safety of the technique. The belly button approach is known to have a high risk of complications. Because of this, the American Society of Plastic Surgeons does not even recognize it as a valid approach for breast augmentation. Another consideration is whether the approach can yield consistently good results. The armpit approach makes it very difficult to control the shape of the breast consistently. The reason is that working through the armpit prevents the surgeon from properly visualizing all aspects of the inside of the breast. Thus, a lot of the shaping of the breast has to be done blindly. Therefore, the results can be unpredictable. The surgeon may have a great result one time, and a poor result the next time. One must also consider the potential side effects and complications from each approach. There have been many studies which show that inserting implants through the nipple/ areola can increase the risk of capsular contracture. Capsular contracture is a condition in which the scar tissue around the implant becomes very tight and hard. This causes the implant to be squeezed and the breast appearance to become deformed. The theory is that making the incision around the nipple and areola cuts into milk ducts which have bacteria in it. The bacteria then get transferred to the implant as it is inserted. Although only a few bacteria get on the implant, it is enough to cause inflammation around the implant which then leads to capsular contracture. Another possible side effect/ complication of inserting implants through a nipple/areola approach is the risk of numbness and/or inability to breast feed. Although these risks exist with any surgery on the breast, it may be slightly higher with the nipple/areolar approach. The last consideration should be the cosmetic appearance of the scar. The nipple/areola scar heals very well. The scar is made in the border between the dark color of the areola and the lighter color of the breast skin. This camouflages the scar very well. However, it is important to understand that all scars, no matter how perfectly they are designed and heal, are always visible. Therefore, the scar on the nipple/ areola will always be slightly visible when the breasts are not covered. The scar in the inframammary fold is designed to fall in the crease that will be formed once the implants are inserted and have time to "drop" to their final position. Even women who do not have a fold or crease to begin with will have a fold or crease after augmentation. Therefore, this scar heals in a location that is never visible, even when nude, unless the woman lifts her breasts. Furthermore, the scar heals very well in this location and eventually becomes a very fine line. For all of these reasons, the inframammary fold is the preferred method of inserting implants for top surgeons. Using the inframammary fold allows for more control over the breast shape, which leads to better and more predictably consistent results, with the least amount of risk and the best chance for a barely noticeable scar.

There are three popular options for incision placement for breast augmentation:1. peri-areolar2. IMF(fold)3. Trans-axillary(armpit)A silicone(gel) or Saline implant can be placed into a breast pocket via any of these incisions. I partially agree with your surgeon, you do have a small nipple-areola area, so the only realistic option for an implant through that incision would be saline. As for the other two options(with a silicone implant), the length of incision will be roughly the same regardless of if it is placed in the armpit or the IMF(fold). If you are concerned about the scar and concealing the incision, the IMF(fold) incision may be your best choice NOT the armpit as while you are wearing tank tops or bikinis and lift your arm up, the scar could/will likely be seen.

This is an excellent question. One of the basic variables in augmentation surgery is where the scar is going to be. The important thing to understand is that their will always be a scar. The surgeons job is to ensure you achieve the best quality scar in the least visible location. Also, the surgeon should not compromise technical "perfection" by choosing a scar location that provides less control over what is being done internally to create the implant pocket and insert the implant.Of course, like most things in surgery you will find differing opinions over what is the "best" approach. With implant placement, 3 incisions/scars are commonly used: armpit; lower areolar border; lower breast fold.Each approach has advantages and disadvantages. - Via the areolar is simply not possible when the areolar diameter is too small and therefore you are unable to pass an implant through a small access hole. Also, should the person scar badly it's not a great spot to have a bad scar - although this could be argued for all techniques.- Via the armpit approach can scar nicely, with no scar associated with the entire breast mound. However, these can scar badly and therefore can never be hidden! A bikini/bra will cover any scar on the breast mound (areolar or lower breast fold). Also, the armpit approach means that the surgeon has the least control and is furthest removed from the areas that he/she needs most control in creating the pocket - the cleavage region. In addition to this, should the patient require any further surgery then it is general not possible to re-use these scars, so the surgeon needs to create another scar (such as in the lower breast fold).- The lower breast fold incision is by far the most popular approach employed by plastic surgeons, and it is how I do the vast majority of my cases. The scar sits neatly within the lower breast fold crease. This approach provides the surgeon with the best control and management of the entire implant pocket and insertion/positioning of the implant. This scar can also be easily re-used should further surgery be required for whatever reason. Furthermore, many would consider that the areolar and armpit approach can result in potential "contamination" of the implant as these areas have a higher bacterial load than the lower breast fold region. Whilst this would logically be correct I'm not entirely convinced it is clinically true and/or relevant. However, its another acceptable argument for not routinely using these approaches.