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Breast Augmentation - Incision Options

How Does the Surgeon Enter the Breast to Place the Implant?

There are four ways to make the incision into the breast for the placement of the implant.

Your cosmetic surgeon will discuss what kind of incision is best for you, depending on your body type, and concerns about scarring and other risks.

Around the Areola/ Nipple

This incision, also known as Peri-Areolar, is one made by your cosmetic surgeon like a half-circle at the outer edge of the areola, the colored area around the nipple. The scar is extremely favorable and blends well with the areola. It grants the surgeon with the best access for precise placement of the implant, resulting in a strong cleavage and better symmetry. There is also better control of any bleeding during surgery, which ultimately affects the chance of scar formation or capsular contraction. Finally, this incision can be combined with a peri-areolar breast lift surgery when indicated.

Although some surgeons believe that the peri-areolar incision carries a higher incidence of loss of nipple sensation, in my experience, if this procedure is performed well there is no increased loss of nipple sensation or inability to breast-feed.

In the Arm Pit
An incision placed in the arm pit is also known as a Trans-Axillary incision. Despite the myth that this scar is usually unnoticeable, it can be more prominent than other scars, especially when a woman is wearing sleeveless cloths. This access point is very far from the central location of the implant making it very difficult to precisely position the implants, thus causing the implants to sit away from each other, creating a wide cleavage. It is associated with a higher risk of bleeding and less control, often forcing the surgeons to use drains which can increase the risk of infection.

In the Inframammary Fold
This is a one to two incision made by your cosmetic surgeon near the under-breast fold. Like the peri-areolar incision, this approach affords the surgeon the greatest control over the position of the implant, giving the patient more attractive cleavage. The final scar is very favorable.

Trans-Umbilical Incision
The Trans-Umbilical Breast Augmentation (TUBA) involves making a one to two inch incision at the edge of the "belly button," through which a long metallic tube is forced towards the breasts. Then the breast implant is folded and pushed through this tube to its final position under the breasts. There have been some reports of complication with the insertion of this tube, when the tube accidentally speared the liver or lung.

This approach has specific disadvantages as compared to the peri-areolar approach. First, because the implants cannot be placed precisely, there is a higher chance of breast asymmetry and of overly-wide cleavage. Second, if a patient also needs a Breast Lift, another incision has to be made around the areola.

This procedure is often marketed as a “Scar-less Breast Augmentation,” but, to the contrary, the scar around the umbilicus could be very noticeable, and at times unsightly, especially if a woman is wearing a shirt that exposes the midriff.

Because this approach can be challenging, and due to its potential complication rate, it should be performed only by a board certified plastic surgeon who has extensive experience with it.

How Do I Decide What Kind of Incision is Right For Me?

This is a decision that you should make after a thorough discussion with your cosmetic surgeon about your particular concerns. For example, advantages of the Peri-Areolar incision include greater control over implant placement, resulting in better symmetry, stronger cleavage, and less noticeable scars. Furthermore, a concomitant Breast Lift can be performed through this incision. However, for women with smaller areolar diameter, there is a greater risk of losing sensation in the nipple.

The Trans-Axillary incision is the method least favored by those who do not want to have a scar in the vicinity of their breast. Although this scar is not less noticeable than infra-mammary and peri-areolar incision. One of its disadvantages is that it does not achieve the most symmetrical result or result in the strongest cleavage. Finally, a Breast Lift or Capsulectomy can not be performed through this incision.
Many surgeons favor the Inframammary Fold because they feel that it gives them the greatest control over placement of the implant and has less risk of affecting nipple sensation as that of the peri-areolar incision. The scar is usually very thin, and hidden under the breast fold, but can be more noticeable when a person is laying on their back.

The Trans-umbilical incision is controversial among plastic surgeons. Those that are apt at performing it brag about its "scar-less" incision, while others feel that it carries an unacceptable potential risk of injuring vital organs during the insertion of the metal rod from the umbilicus towards the breasts. Finally, its use is only limited to the simplest form of Breast Augmentation, not allowing surgeons to manipulate the implant, or to perform a Breast Lift or Capsulectomy.

Every woman has different needs, and wishes concerning scarring, recovery time and the amount of pain that she feels she can tolerate. Therefore, thoroughly discuss your options with your cosmetic surgeon, and be certain that he or she is highly experienced in the methods that you choose.

During your consultation with Dr. Younai he reviews your treatment options and choices of different incisions and routes of implant insertion, including pros and cons of each techniques, potential risks and complications, recovery course, pre and post operative instructions, and esthetic outcomes. You will also have an opportunity to "try on" different types of saline or silicone breast implants. There are also many before-and-after pictures and high resolution images of breast augmentation Scars available in our photo gallery.

Dr. Younai is a board certified plastic surgeon who receives patients at the California Center for Plastic Surgery from the Northern as well as the Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.

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Dr. Sean Younai
is a Board Certified Cosmetic Plastic Surgeon, who practices in Encino, Los Angeles, Southern California.
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