Breast Augmentation – Approaches to enhancement

Breast Augmentation – Approaches to enhancement

There are a number of different incisions used regarding breast augmentation.  They all have advantages and disadvantages.  With the recent FDA approval of silicone implants, the use of each incision has changed because most women want silicone implants, which do offer a superior look and feel.  There are four approaches to placement of a breast implant:

  • Inframammary – This approach involves an incision in the crease between the chest and breast. This is the most common approach used for breast augmentation in the nation as it allows excellent control of the breast pocket with a very well hidden scar.  I use this approach commonly in patients who have a well developed inframammary fold.


  • Periareolar – This approach makes an incision at the border of the nipple and the skin. This incision is best for women with pale skin and a “salmon” colored nipple.  This incision is well hidden when placed at the appropriate level.  I tend to avoid this incision, however, as it is COMPLETELY VISIBLE TO THE PATIENT.  This is the only incision which I get complaints about.  Because of that, I tend not to advocated this approach.


  • Endoscopic-Assisted Transaxillary approach – I can place a saline or silicone prosthesis WITHOUT ANY INCISION ON THE BREAST!!.  With the endoscope, I have complete surgical control and can create any size pocket necessary.  This is the most advanced and difficult technique in breast augmentation.  I use it routinely when women want to avoid incisions on the breast.


  • Umbilical Approach (TUBA) – I do not use this approach. Having said that, it is a very acceptable approach to breast augmentation.  The problem with it is that you can only use a saline implant.  The overwhelming majority of my patients receive silicone implants because it is a superior product.  If you are interested in a saline augmentation, consider this approach.  Otherwise, avoid it.

Silicone implants come prefilled.  Because of this, the incision size can vary depending upon how large you want to be.  This is another reason why the periareolar incision can be dangerous.  If you have a smaller sized nipple, and you are looking for a greater than 300cc implant, it is very likely that you will run into problems with your scar.  Hiding the incision beneath the breast obviates the different scar size, as does placing it in the armpit with an endoscope.

Alan Durkin

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