Breast Augmentation Approaches
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:
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. Benefit of this approach is that, if any issues arise with the incision, it is easily modified or revised, as there is plenty of skin to recruit in this area without altering the shape of the breast or nipple/areolar complex.
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. Also, this approach does not lend itself towards revision, as any revision will create a secondary alteration to the shape, volume, and position of the areola.
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. The liability of this approach is that it is limited to specific patients, and that the recovery from this approach is longer than other approaches because the entire pectroralis major muscle must be mobilized. This approach is not as common with my Florida patients, as the incision will be visible in the armpit. As most Floridians have some form of watersport as a hobby, covering this incision can sometimes be problematic. This approach is more common in pateints from the Northeast and Southwest United States, as those patients tend to have less watersports, and more landsports (and more shirt wearing!)
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. For silicone breast augmentation, which we strongly favor, umbilical approaches are not an option.
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 problematic 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.
Silicone implants come prefilled. Because of this, the incision size can vary depending upon how large you want to be. At Ocean Drive Plastic Surgery, we use what is called a “Keller Funnel” during each augmentation case. This allows us to limit the incision to 3.5 centimeters to 4centimeters in size when placing smooth, round silicone implants. Hiding the incision beneath the breast obviates the different scar size, as does placing it in the armpit with an endoscope, but in every case, we strive to make the smallest incision possible. Shaped, or anatomic implants require a slightly larger incision for placement, and they are always placed via an inframammary approach.
To minimize incision size, and as well improve patient safety, we use a Keller Funnel® for each case. Because of this simple but elegant invention, we are able to markedly limit the size of incision needed regardless of the size of implant used.