Breast Augmentation Incision Sites
Overview
Breast augmentation involves surgeons placing implants using different incision types, each with its own benefits and considerations. The most common sites are inframammary (under the breast fold), periareolar (around the nipple), and transaxillary (through the armpit), depending on the patient’s needs and goals.
The choice of incision can affect scar visibility, implant placement, and post-surgical appearance and feel. Factors like implant type, breast anatomy, and personal preferences all play a role in this decision. Understanding the differences between incision types helps patients feel more confident and prepared for their procedure.
Understanding Breast Augmentation Incision Sites
Surgeons perform breast augmentation by making precise cuts, known as incision sites, to insert implants. These incisions are important for overall results, including scarring, healing, and implant positioning.
What Are Incision Sites?
Incision sites are the specific locations where plastic surgeons insert breast implants. The four main types are:
- Inframammary: Easy access, good control, and scars hidden in the fold.
- Periareolar: Scar blends with nipple edge, but may affect feeling or breastfeeding.
- Transaxillary: No breast scars but less direct view.
- Transumbilical: Rarely done, more complex.
Surgeons and patients select the site based on goals, anatomy, and the surgeon’s experience.
Importance of Incision Placement
The location of the incision impacts results, especially in terms of scar visibility, healing, and breast appearance. Well-placed incisions help surgeons control implant position and shape, creating a more natural look.
Poor placement can lead to unevenness or complications. The surgeon’s technique also matters for future adjustments or implant replacements, making proper incision choice a key part of surgical planning.
Factors Influencing Incision Choice
Several factors influence incision selection, including:
- Body shape and breast size
- Skin type and tissue quality
- Implant type and size
- Patient preferences (such as wanting hidden scars)
- Plans for future breastfeeding or previous surgeries
During the consultation, the plastic surgeon evaluates your medical history and anatomy to recommend the best approach. The surgeon’s experience and current medical guidelines also shape the decision, helping ensure a safe and satisfying outcome.
Inframammary Incision Approach
The inframammary incision, also known as the breast fold incision, is the most common choice for breast implant insertion. This approach places a small cut in the crease under the breast, called the inframammary fold.
Key Features:
- Location: Crease at the bottom of the breast.
- Typical Size: About 1.7 to 4 cm, depending on the implant and technique.
- Visibility: Scar is usually hidden in the natural fold.
The surgeon makes the incision at the base of the breast, centered along its meridian line. By using this location, they can place implants with direct visibility and control, which often helps with symmetry. Many patients prefer this method because the scar is less noticeable. Clothes and bras generally cover the inframammary incision site.
Benefits and Considerations
| Benefit | Detail |
|---|---|
| Direct access | Implant placement is more precise |
| Lower risk to nipples | No cuts around the nipple or areola |
| Hidden scar | Scar sits in the natural breast fold |
Possible drawbacks may include a visible scar when lying flat, especially if the breast is small and the fold is shallow. Scarring varies by skin type and healing process. The inframammary approach works for silicone and saline implants. Surgeons often recommend it for patients who want more control over implant placement and future adjustments.
Periareolar Incision Approach
The periareolar or areolar incision circles the edge of the areola, which is the darker skin surrounding the nipple. This approach uses the natural color difference between the areola and breast skin to help hide the scar.
Key Points
- Incision follows the border of the areola.
- Used for both saline and silicone implants.
- Allows access to all common implant positions.
Many surgeons choose this method for patients who want a discreet scar. The location of the cut means the scar often blends in well and is less visible as it heals. This approach provides the surgeon with good control when creating a pocket for the implant. It also works for implants placed above or below the chest muscle.
Possible drawbacks include a higher risk of changes in nipple sensation and potential difficulty with breastfeeding. The periareolar incision might limit the surgeon’s ability to expand the opening if a larger implant is needed.
| Pros | Cons |
|---|---|
| Scar may be less noticeable | Can affect nipple sensitivity |
| Good access for implant placement | Risk of issues with breastfeeding |
| Suitable for different implant types | Incision length may be limited |
The periareolar approach is a well-established technique. It may be most suitable for patients who are concerned about visible scarring and are comfortable with the possible risks.
Transaxillary Incision Approach
With the transaxillary approach, the surgeon makes a small incision in the natural crease of the armpit. This is called a transaxillary incision. The surgeon inserts the breast implant through this cut, using a tunnel created behind the breast tissue.
One main benefit is that there are no scars on the breast itself. This makes any scars less visible since they are hidden in the armpit area. It can help patients feel more comfortable wearing swimsuits or clothing that shows the chest.
Common Features
- Incision is usually 2.5 to 3 centimeters long.
- Hidden in the armpit crease.
- No cuts on the breast skin.
Surgeons may use this method for both saline and silicone implants, but special skills and tools are often needed, especially for silicone options. Not all surgeons offer the transaxillary breast augmentation due to the required training and experience.
Pros:
- No breast scar
- Hidden incision
Cons:
- Possible need for extra equipment
- May be harder to adjust implant position after surgery
Some patients prefer the transaxillary approach because the breast skin stays untouched, and there’s less risk of visible breast scarring. However, it may not be suitable for everyone, so a consultation with a qualified surgeon is needed.
Transumbilical and Less Common Incision Sites
The transumbilical incision, also called the TUBA (Trans-Umbilical Breast Augmentation), is one of the least common ways surgeons place breast implants. In this method, the surgeon makes a small cut in the belly button (navel) and moves the implant up a tunnel under the skin to the breast.
One advantage of the TUBA incision is that it leaves no scars on the breasts. Instead, the scar is hidden in the natural folds of the navel, making it hard to see. This approach does not cut into breast tissue, but tissue can still be disturbed as the implant is inserted.
Key Facts
| Feature | Detail |
|---|---|
| Location of incision | Belly button (navel) |
| Visibility of scar | Usually very well hidden within the navel |
| Implant placement | Requires tunneling from belly button to the breasts |
| Commonness | Less common than other techniques |
| Types of implants used | Usually saline implants only |
Other rare incision sites, like the transaxillary (armpit) or transabdominal methods, follow similar principles. These approaches often try to minimize visible breast scars. Some people may not be good candidates for these less common sites. Choosing the right method depends on the person’s body, the type of implant, and the surgeon’s expertise.
Comparing Incision Types for Breast Surgery
Choosing an incision site for breast surgery affects both healing and how visible scars will be. Each type of incision may result in slightly different recovery times and levels of scarring.
Scarring and Healing Process
The main incision types are inframammary, periareolar, and transaxillary.
- Inframammary incisions are made in the fold under the breast. They usually heal well and leave a scar hidden in the crease. This approach also allows surgeons good access and direct visibility, which may lower the risk of complications, such as capsular contracture.
- Periareolar incisions are made around the edge of the nipple. Scars can blend with the natural change in skin color, but these can be more noticeable if the border is uneven. Healing may take a bit longer, and there is a small risk of changes to nipple sensation.
- Transaxillary incisions are placed in the armpit. This technique leaves no scars on the breast itself. Recovery can sometimes be more uncomfortable, and access for implant placement is less direct.
Recovery time varies based on the individual and incision type, but most patients return to normal activities in several weeks.
Visibility of Surgical Scars
Where the surgeon places the incision affects how visible the surgical scar will be over time.
- Inframammary scars are often hidden by the natural breast fold, so they are not visible when standing.
- Periareolar scars may be seen if the border of the areola is irregular or if the scar does not fade well over time. Skin color differences between the areola and breast tissue can make the scar less noticeable.
- Transaxillary scars are hidden in the armpit, so there is no scar on the breast itself. However, this means that the scar may be visible when the arm is raised.
Most scars fade with time but never disappear completely. Healthnile states that following postop care instructions and minimizing sun exposure help scars heal and fade as much as possible.
Impact of Incision Site on Breast Implant Choices
The location of the incision during breast augmentation can affect what type of breast implant is used and how the surgeon inserts it. These factors are important when deciding on silicone or saline implants.
Silicone vs. Saline Implant Compatibility
Surgeons often use silicone breast implants that are pre-filled, making them less flexible during insertion. Because of their size and firmness, surgeons may need to make larger incisions. The inframammary and periareolar incisions usually work best for these implants.
Surgeons insert saline implants empty and fill them once they are in place. This allows for a smaller incision, making options like the transaxillary site more practical. However, some patients and surgeons still prefer inframammary or periareolar incisions for both saline and silicone implants, depending on the case.
Table: Incision Site and Implant Compatibility
| Incision Site | Silicone Implants | Saline Implants |
|---|---|---|
| Inframammary | Highly suitable | Suitable |
| Periareolar | Suitable | Suitable |
| Transaxillary | Less suitable | Suitable |
Breast Implant Insertion Challenges
Silicone gel implants often require bigger incisions because they are pre-filled and less flexible. This can result in longer scars with the inframammary approach. The transaxillary and periareolar sites can make placing silicone implants harder and may raise the risk of implant damage or improper position.
Because surgeons fill saline implants after placement, they can insert them using a smaller incision. This makes them more compatible with less visible incision sites, such as the transaxillary region. However, the ability to use a smaller incision is often weighed against the surgeon’s skill and the patient’s anatomy.
Some surgeons also use a Keller Funnel, a special device that helps insert silicone implants through smaller incisions. This tool is not always available, and its use may depend on the surgeon’s experience.
Long-Term Considerations and Recovery
Breast augmentation recovery requires time and care, especially around the incision sites. Most people notice the initial healing within a few weeks, but complete recovery often takes several months. Recovery time varies based on incision location, implant type, and whether the pectoral muscle was involved. For example:
| Recovery Factor | Typical Time Range |
|---|---|
| Initial Healing | 1-2 weeks |
| Resume light activity | 2-4 weeks |
| Final results | 3-6 months or longer |
Individuals should monitor their surgical sites for any signs of infection, unusual swelling, or scar changes. Providers can help spot any concerns early through regular check-ups. Breast implants do not last a lifetime.
Many people replace implants after 10–20 years, often due to leakage, rupture, or cosmetic concerns. Some people worry about breastfeeding after breast enhancement. Most can breastfeed, but it may depend on the incision site and implant placement. Scars from incisions usually fade with time.
Using scar creams, sun protection, and following your provider’s aftercare instructions can help scars heal better. Maintaining a healthy lifestyle and avoiding high-impact exercise early on support better long-term results. Monitoring the breasts, especially after any changes, helps ensure implant safety and good outcomes.
