There are several options for placement of breast implants. There are pros and cons to each. Ultimately, the choice is yours and your surgeon’s after a discussion of each. Here is a synopsis of the different types of incisions that you could do to have your breast augmentation.
Placement of the Scar
There has to be a scar somewhere on your body in order to place implants, but the size of the scar and where it is placed can determine whether it is noticeable or not. There are several areas where scars can be placed: under the lower fold of the breast, around the areola, in the armpit, or in the belly button.
Most women prefer the scar under the fold of the breast, also called the inframammary fold or the IMF. If saline, the scar is around 3 cm long; if silicone, it is around 5 cm long. The scar is usually not noticeable standing or sitting but can be seen when lying down. This doesn’t bother most women usually and is preferred to obtain the best dissection of the pocket for placement of the implants.
Peri areolar Scar
Although some say the scar around the areola is not as noticeable, sometimes it is because of different pigmentation of the scar when it is healed. This is called a peri areolar incision and can allow for very good access all around the pocket. However, due to the possibility that it can be noticeable when the breasts are looked at while standing or sitting, it may not be the preferred route for you. The lengths of the incisions are the same as with the IMF, only in a round fashion around the areola.
Trans axillary Scar
To avoid any scars on the breasts, one option is to make the scar in the armpit and insert the implants through this incision. This requires extra skills of the surgeon if not trained in doing this technique. If not performed correctly, dissection of the lower muscle may not be adequate, resulting in the implants riding high. In addition, this technique is associated with a higher risk of other potential complications such as pneumothorax, and thus is not the preferred method by most surgeons.
A unique method of breast implant insertion is through the belly button. Only saline implants can be placed in this manner. In this technique, a small incision is placed in the upper part of the belly button. Tumescent fluid is used to numb the area from the belly button to the breasts. This can give good anesthesia, but most women prefer being put to sleep for this due to some discomfort during the procedure.
A large tube is then placed into the belly button incision, pushed through the subcutaneous tissue of the upper abdomen and into the bottom of the breasts. The pocket is then developed with special long instruments. A breast expander is then introduced to spread the breast tissues. The expander is deflated, and the implants inserted.
As mentioned, only saline implants can be used for they are the only ones that can fit into the large tube from the belly button to the breasts. Once inserting, the implants are inflated, and any adjustments are made as needed with special long instruments.
Potential problems from this is inadequate dissection of the breast and muscle tissues, since the pocket is developed under the muscle. If inadequate dissection of the muscle is done, the implants may ride high. If this persists, another procedure would be necessary 6 months later, and then the patient would receive the IMF incision anyway to do the adjustment and bring the implants down.
There are several places on the body where incisions can be made for insertion of implants. Each has its own pros and cons. Most physicians use the IMF incision since dissection is done best through this incision and the scar is hidden well. The choice, of course, is up to the patient ultimately. At our office, we try to do what the patient wants so she gets the breasts that she wants.