Although there are 4 possible incisions for placement of a breast implant, by far the most frequently used are in the fold under the breast (IMF) or along the border of the lower half of the areole (peri areoler). Much less frequently used, for various reasons are the axial lady (in the armpit) or through the belly button. Patients sometimes like the peri areoler incision because the scar is well camouflaged between the darker areoler color and the lighter surrounding skin. Studies have shown that this incision doesn't lead to any more change in nipple sensation than other incisions. If the patient has a well defined inframammary fold, then the incision placed in the fold below the breast is well hidden, this incision is sometimes easier to do use. There is a recent theory that working through the peri areoler incision might lead to an increased risk of scar capsule contracture, the tightening of scar tissue around the breast implant due to presence of normal bacteria within the breast ducts and gland. Therefore, more surgeons seem to be returning to a preference for the inframammary fold incision. In the end, the incision choice is a personal one depending on where you would rather have the final scar, but be sure to discuss this thoroughly with your plastic surgeon.
The periareolar approach should not affect your nipple sensation or projection. It is a good approach for a well pigmented areolar border and for patient's without a well defined inframammary fold. The inframammary fold approach is preferred for patients with a well defined fold.
The incision associated with the lowest risk of infection and nerve injury is the mammary fold incision. It may not always be the best choice from an aesthetic standpoint but the benefits of this incision are such that most of my current patients choose this incision. However, ultimately the patient can decide which incision they want once they know the pros and cons of each approach. Best of Luck Dr Harrell
Thanks for the question. I recommend you to send your photos to us to give you the advices you want and need.Kind regards,Dr. Emmanuel Mallol.-
There are advantages and disadvantages of the various breast augmentation incisions. In general, the fold incision has the lowest risk of complications as it provides the most direct access. For this reason I recommend this incision most frequently, particularly when there are breast asymmetries in size and shape, as it provides the most control for creating the pocket accurately in all areas and accurate implant placement. Nevertheless, for patients with ideal breast shape, position and symmetry, any of the other incisions, transaxillary, areolar and even transumbilcal or TUBA (saline only) will work. The best way to approach this is to have a discussion of the pros and cons of the various incisions with a surgeon who is comfortable with all incisions, so you can choose the best option for you. I do not believe that the areolar incision necessarily increases the risk of sensory loss, rather excessive stretching, often with too large implants. to the nerves as they enter the tissues from the side is a more likely cause
What a good question? Over the years I have used the transaxillary, peri areolar and inframammary incisions, and must admit that today I focus heavily on the inframammary incision for my patients. For selected patients a peri areolar incision may be considered, but the lowest potential for capsular contracture, malposition of the implants, numbness to the nipple, the least amount of distortion to the areola has to be the inframammary approach. A tear drop, gummy bear implant is also less compressible because of the firmness and excellent form stable nature of the implant requires introduction of the implant below the muscle and breast requires a slightly longer incision. This is all beneficial for the patient and should be considered.
Good luck to you.
Frank Rieger M.D. Tampa Plastic Surgeon
Each surgeon ha their own preferences. So there is NO correct response. I prefer infra mammary for less sensitivity N/A issues, easier implant sub muscular placement, fastest healing. Next circumareolar incision but the risks of sensory changes to N/A if 50% and the potential loss f ability to breast feed.plus slight increase infection risks, Next the trans axillary incision though essential a blind operation, increased risks of poor implant placement, risks of axillary scarring and or nerve injury. Finally trans umbilical - Never would offer!
Since I believe Mentor Siltex (textured) gel fill breast implants are best for most patients, I think a peri incision of the lower half of the areolar is best. While a trans axillary incision is great for smooth walled silicon gel or saline implants, it doesn't work for textured gel implants because you can't correctly position the implant through this incision. With textured implants it is critical that they are positioned or you will get fold the create problems. You could use a infra mammary incision but that scar is more noticeable and can some times be quite promenade. In my hands the textured implants are preferred because they are less likely to develop capsular contracture (get hard), show ripples, and very significantly they are not at all frequent to slide around under the breast and slide out into the axilla (arm pit) or to bottom out (slide down below the infra mammary crease. They stay where you put them and they make your breast look and feel like your breast is just larger and not implanted. Some Plastic Surgeons claim that using a peri areolar incision is associated with increased capsular contraction I have studied my rate of capsular contraction and it is only 0.7 %. In my opinion it is important to use a triple antibiotic solution in the breast pocket, and to put the implant into the pocket with Keller funnel after changing into fresh sterile glove before touching the implant (a no touch technique).
There are 4 incision locations for breast augmentation, and the choice is determined by a combination of surgeon and patient preference, implant size, and anatomy.
1. Umbilical or bellybutton incision: This is only for saline implants and is offered by very few surgeons since there is very limited visibility for placing the breast implant. You cannot replace implants or revise any implant surgery through this incision.
2. Axillary or armpit incision: Women and surgeons prefer this because it does not place a scar on the breast. However, if there is poor healing it may be seen in tank tops and sleeveless dresses. So it is most useful for saline or small silicone implants, and it may be more difficult to do revision surgery in the future. I personally avoid this incision because of these reasons and because of the theoretical potential for interference with lymph node testing if a patient was to ever develop breast cancer.
3. Periareolar incision: This incision can be used in most patients, but it may be difficult to insert a large implant through a small areola. Although the percentages are small, there is a slightly higher risk of capsular contracture and infection through this incision. This may be reduced using the Keller funnel prevent contact of the implant with the skin and breast tissue during placement. If the scar heals well it is extremely inconspicuous. But some patients heal with wide or indented scars. If you desire this technique make sure your surgeon is experienced with it to reduce these risks.
4. Inframammary incision: This incision offers great visibility for placement of large implants, is straightforward for dual plane, and can be used for even the most difficult revision surgeries in the future of needed. It has a higher rate of numbness of the lower breast skin, but it heals well in almost every patient.
Each incision has a risk of changing nipples and Seshan. This is more related to implant size than incision choice. Since scars themselves can become numb or sensitive, that may mean the periareolar incision would have a slightly higher rate of sensation changes.
Hi Official,We let all of our patients pick their own incision if they have normal anatomy. Most patients pick the armpit incision because they don't want a cut on their breasts. For the "dual plane" we like the incision in the breast fold. The areolar incision is very inconspicuous, and some studies state there is higher numbness in the nipple area. So we do them all. I put a journal article and a video below on our most popular requested incision, armpit. Here are some extra thoughts on our most popular request: The Aesthetic Surgery Journal published an article several years ago proving that the armpit incision has less bacteria than the breast fold incision or the nipple incision. This paper, published on April 26, 2011 by Dr. Sophie Bartsich, is from the prestigious New York Presbyterian Hospital and Columbia University Medical Center and is titled “The Breast: A Clean-Contaminated Surgical Site”. The investigators proved scientifically that the nipple region demonstrated a bacteria concentration which was five times higher than the breast fold site which demonstrated a concentration four times higher than the armpit (axillary) area! Much has been published in our plastic surgery journals on the armpit breast augmentation in recent years. Another study which is in the link below from the Aesthetic Surgery Journal showed a lower infection rate than normal in 2,000 patients undergoing an armpit (axillary) breast augmentation. These Plastic Surgery Journals are “peer-reviewed” and edited, they are the gold-standard in our field as being valid science. You may review the web reference below from the Aesthetic Surgery Journal and you will see the axillary BA method outlined. The website below also has videos showing patients with axillary incisions demonstrating the quick recovery routine postoperatively. BTW, there is no problem with placing large gel implants through the armpit. All the best, Dr. Joe