What Incision is Best Recommended for Larger Implants and for Someone That Keloids Easily? (photo)

I'm looking to get rather large implants (around 650cc) I'm 5'1'' and 105lbs and I am going to be topless a lot and I don't want any visible scars on breasts. My surgeon recommended silicone crease incision but I worry about scars. I understand the areola and crease scars are good because a bra and a shirt can cover it but I plan to be topless a lot. I have a history of getting bad scars and keloids. Would armpit incision be the best and is it possible for large implants?

Doctor Answers 5

Incision choice for breast augmentation

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The best choice for incision in breast augmentation for short term results, avoiding problems, and for long term (replacement or revision) has turned out to be in the center of the inframammary crease beneath the breast. This can be 2 cm for saline-filled implants that come empty and would be about 3.5 cm for a silicone gel implant of normal size using a Keller funnel. 

The resulting scar appearance cannot be guaranteed but generally the crease scars well and hides the scar well. 

The size implant you have chosen based on the idea that you can pick whatever size you want and result you want, is far too big for your breasts to accommodate in one operation and you are asking for distortions, problems, and malposition. The largest implant that will fit and look right with a minimum risk of problems would be a high profile saline-filled (Allergan) or high profile gel-filled (Mentor or Allergan) that fits the width of your breast and will fill it out by about two cup sizes. I would guess this would be more in the range of 400 cc's but it's best determined by measurement and profile choice. 

Boulder Plastic Surgeon

What Incision is Best Recommended for Larger Implants and for Someone That Keloids Easily?

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There is no correct or in correct choice. But going to over sized implants I would use the crease incision less than 2 cm in size, wide dissection, insertion of deflated implant to be inflated in the pocket. 

Scarless breast augmentation

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I agree with Dr. Kraft in that most people call bad scarring keloid and this may not be the case in you. You are a good candidate for TUBA(Trans Umbilical Breast Augmentation). In this procudure saline implants are placed through your belly button, hence no visible scar. Only kaveat is that you have to have saline implants. Silicone implants can be placed through an areolar incision with the use of a Keller funnel. 

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 112 reviews

Best augment incision for keloiding

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First, I'd like to see what you define as "bad" or keloidal scars. Keloids are literally tumor growths which may form at the site of surgical incisions. Hypertrophic scarring is not the same condition. Depending on the method by which the skin is closed, scarring can be mitigated which is why so many patients request plastic surgeons for their lesion excisions or to suture trauma wounds. That said, there is no way to hide an areolar scar; if it heals well, then the scar is virtually undetectable but if it heals badly...... The infra-mammary crease scar is hidden by the breasts except when you are lying down. The axillary approach is inappropriate for insertion of extremely large implants. The larger you choose to go, the greater the stretch on the skin and the higher risk in terms of scarring. The size that you are considering is extremely large for your height and weight. If you are a toples dancer, you must take into consideration the risk that poor scarring will have on your livelihood.

You have a problem

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It looks like you have small areolae. Thus a circumaeolar incision which in my hands, gives the best, most hidden scar is not possible. Inframammary scars are usually visible. Axillary scars dont allow most people to put in very large implants, so it seems as if you have a problem.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

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