Making Scars the Least Visible as Possible
Breast augmentation is an invasive cosmetic surgical procedure that involves the insertion of breast implants into the body via an incision(s). Depending on the size of breast implants you desire along with your physicality, incisions can be made in a variety of locations around your chest area. The most suitable location(s) will be left to the discretion of the physician performing the breast augmentation procedure in consultation with you (the patient). Incisions can be one of the following: Axillary, Inframammary, Periareolar, or Transumbilical.
Inframammary incisions are made under the breast, where the breast meets the torso (otherwise known as the inframammary fold). This is the most popular type of incision for breast augmentation as it allows the surgeon maximum precision when placing the breast implant and is generally seen as producing the most symmetrical results. Scarring is also typically not as noticeable since inframammary incisions are placed within the fold of the breast crease. Another benefit is that if reoperation or revision is necessary, the same incision location can be used for future surgical procedures with no new scarring necessary. However, if you choose to go with a different implant size in future breast augmentation procedures, the scar may become more visible due to the change in breast size.
Furthermore, because the surgeon is able to work a lot closer to the breast cavity, the risk of complications is greatly reduced (such as the potential for infection) since incisions are made away from the milk ducts. Inframammary incisions also offer the greatest level of choice in terms of type and placement of implants, as they can accommodate both silicone and saline implants, as well as subglandular (above the muscle, below breast tissue) or submuscular (below the muscle) placement. Finally, inframammary incisions, compared to periareolar incisions, also lead to fewer breastfeeding complications.
- There is a lowered risk of breastfeeding complications following breast augmentation.
- There is a lower risk of infection compared to the periareolar incision as the surgeon avoids the milk ducts.
- Your surgeon works closer to the breast cavity (as compared to the axillary/trans-umbilical) and has much more control during the placement of the implants. This in turn lowers the risk of complications.
- If a second surgery is required, the same incision line can be re-used so as not to create another scar.
- Inframammary incisions offer the widest variety of options for implant types and locations. They can be used for above the muscle or below the muscle, saline or silicone breast implants.
- While the scar is hidden under the breast fold, it can still be visible (particularly after implant removal or size revision).
- There is a risk that the scar will be darker as the skin on the lower breast is much thicker than the skin around the areola.
Periareolar is another common incision that can be used for any type of breast implant (saline or silicone) and placement (submuscular and subglandular). The incision is made along the lower border of the areola (the darkened area that surrounds the nipple). Because the nipple-areola complex has high blood flow and the skin of the areola is thin, the area is ideal for making an incision for breast augmentation as these two properties promote healing and minimize scarring. Also, because periareolar incisions are made along the lower border of the areola, scarring is virtually invisible. Furthermore, the incision site can be reused for breast implant replacement or revision. Another benefit of periareolar incisions is their proximity to the breast implant placement site, which allows for better surgical precision.
The disadvantages of periareolar incisions mostly centre around their proximity to the nipple-areola complex and milk ducts. Chief among possible complications are loss of sensation around the nipple, issues with breastfeeding, increased risk of infection via the milk ducts, and a greater incidence of capsular contracture (a tightening of scar tissue around the breast implant). Also, because of the relatively small incision size, periareolar incisions are less ideal for silicone gel breast implants. Your surgeon at Toronto Cosmetic Clinic will go over all these risks with you before deciding if this is the right choice for your breast augmentation.
- This incision location allows the surgeon maximum precision over breast implant placement and lowers the risk of complications during surgery.
- Periareolar incisions result in minimal scarring due to the natural darkness of the areola.
- In the case of breast implant revisions or reoperation, the same incision site can be re-used with no need for additional scarring.
- Periareolar incisions can be used for submuscular and subglandular placement.
- High blood flow and thin skin of area surrounding nipple-areola complex promotes healing and minimizes scarring.
- Some women report being unable to breastfeed following periareolar incision procedures.
- Possible loss of sensation in nipple.
- Heightened risk of infection via milk ducts.
- Greater incidence of capsular contracture.
- Not ideal for silicone breast implants.
Transumbilical Incision (TUBA)
Transumbilical incisions are the newest form of breast augmentation incision. They are made along the navel (belly button) and tunnel under the skin of the abdomen through to the breast cavity. The benefits of this incision type include minimal scarring and a reduced, less painful recovery time. Unfortunately, the technique can only be used for saline breast implants with a submuscular placement as they need to be inflated after they are placed within the body. This, coupled with the increased risk of complication, lowered precision, and the inability to reuse the same incision site in the case of revision, makes transumbilical incision generally unpopular among most physicians.
- Technically the least invasive breast augmentation incision type.
- Scarring and recovery time are reduced compared to other breast augmentation incision types.
- These incisions are limited to saline implants and submuscular placement.
- The same incision point cannot be reused for revision or reoperation of the breast augmentation. Your surgeon will have to use another incision type for any corrections needed.
- High risk of complications.
- Low precision in placing the breast implant.
Axillary Incision (Transaxillary)
Axillary (or transaxillary) incisions are made under the armpit, allowing for breast implants to be placed either below the muscle (submuscular) or above it and under breast tissue (subglandular). Because the axillary incision is well hidden in the armpit, scarring tends to be minimal. Any scars will generally heal well if carefully placed in a naturally occurring crease and typically can only be seen when the arm is lifted.
Due to the complexity of axillary incisions, your surgeon will use an endoscope (an instrument used to view the interiors of hollow body cavities) while performing the surgery.
Axillary incisions are more commonly used for saline implants, which are filled with the saltwater solution after being placed in the body. While it is possible to use an axillary incision for a silicone gel breast implant, it is not ideal when compared to other incision types. It should also be noted that certain breast types are not compatible with axillary incisions. Breast shapes not suited for axillary incision include: tubular breasts; breasts with a constricted lower pole; and breasts with severe ptosis (excessively drooping or sagging). Your surgeon at Toronto Cosmetic Clinic will examine you and go over this at your complimentary consultation. Furthermore, should breast implant replacement, revision, or reoperation be necessary, another incision will have to be made as axillary incisions cannot be reopened.
- Implants can be placed either above (subglandular) or below (submuscular) the chest muscle with axillary incisions. The choice is not available with other incision types.
- Axillary incisions provide the surgeon with a good access to the chest muscle
- Axillary incisions do not scar the breast itself.
- Is typically only used for saline breast implants. Generally, axillary incisions are not suitable for silicone breast implants.
- The surgeon works very far from the chest cavity, making it more difficult to control. Axillary incisions require a more skillful and experienced surgeon to lower risks of complication.
- There are certain types of breasts that are not suitable for this technique. Your surgeon will assess you to see if you are a suitable candidate for an axillary incision.