Hi, I'm Dr. Michael Epstein and I'm going to answer a question in RealSelf. This question is regards to incision choice during breast augmentation surgery. This is a question that is frequently posed to me during the breast augmentation consultation. There are a total of four different types of incisions that can be utilized for breast augmentation surgery, either in the axila or the armpit, just underneath the areola, in the inframammary crease or fold at the bottom of the breast, and the fourth one which is rarely or more rarely used, is the umbilical incision.

I can tell you right off the bat I don't typically use the umbilical incision. I find that all of the incisions heal well enough that putting an incision down in the umbilicus and adding some of the problems that are associated with that incision, it's just not worth it. And it can only be used for saline implants and the majority of the implants that I put in are typically silicone gel. So that's immediately ruled out.

Over the last five years, I have preference toward inframammary, the inframammary incision. That's the one that's directly underneath the breast, in the crease. I think it heals up incredibly well. I believe that there's a lower risk of loss of sensation to the niple and areola. If the patient is young and has never been pregnant and plans on breastfeeding in the future, there may be more problems with breastfeeding if you're using the peri-areolar or the infra-areolar incision. And one of the biggest problems with the axilar incision, again is the distance away from where the implant needs to be seated, and there tends to be more problems with the positioning of the implant through that incision choice. But the most overwhelming reason why I've switched to the inframammary skin incision primarily is because of the lower incidents of capsular contracture which is really... probably one of the most prominent problems that a patient can get into with breast augmentation, and so we want to try to reduce the risk of that as much as we can, and there's now pretty good data to more than suggest that you can lower the incidence of capsular contracture by putting an implant in trhough the inframammary crease.

Hope this answers your question. Thank you very much.

Breast Augmentation: Pro and Cons of the 4 Types of Incisions

Dr. Michael Epstein answers a question from a RealSelf user regarding the various incision areas in breast augmentation. He discusses the four types of incisions that may be used and the pros and cons of each one.