Incision And Placement Options For Breast Augmentation

Breast augmentation is a highly personalized procedure with many options beyond the numerous types of breast implants. There are multiple incision patterns that can be used as well as various placement options within the breast pocket. These decisions can affect the appearance of the scar and the breast, meaning they’re crucial for attaining a fully natural breast enhancement result. Dr. Wallach will help you make this decision through personal consultations leading up to the surgery itself.

Breast Augmentation Incision Options

Inframammary Incision (In The Breast Crease)

The most commonly used incision pattern is an inframammary scar, resulting in a scar in the crease under the breast, where it is easily concealed.

Advantages:

  • It provides very good access to visualize the pocket and to treat bleeding points.
  • Good visualization means higher precision and better results with low risks of complications.
  • Either saline or silicone gel implant placement is possible through this incision.

Disadvantages:

  • The scar can be more noticeable because of stretching.
  • Tattooing may be required to camouflage the scar.
  • There is a slightly higher tendency for the inframammary fold to be undermined and create a deformity (“double bubble”).

Periareolar incision (Around the Areola)

In some cases, an incision can be made in the transition from areola to breast skin, which is not easily seen due to the change in pigmentation. This approach makes it is less likely to create a “double bubble” deformity of the fold.

Advantages:

  • The final scar usually blends in well with the change in color from the areola pigment to the surrounding breast skin.
  • This approach gives good visualization of the pocket to Dr. Wallach.
  • Many breast deformities and asymmetries can be treated through this breast surgery approach.
  • There is usually good visualization to design the pocket, treat bleeding points, and divide the pectoralis muscle if placing implants in a subpectoral pocket or creating a subglandular pocket.

Disadvantages:

  • Sometimes the scar is noticeable and may require scar care to better camouflage the incision.
  • If the areola is too small it may not be of adequate size to allow for placement of a saline or silicone gel implant.
  • Saline implants can be placed through a smaller areola than silicone breast implants.

Axillary Incision (In The Armpit)

An approach not often used for breast augmentation is an incision in each underarm, through which Dr. Wallach creates a pathway to the breast tissue to avoid leaving any visual scar on the breast itself.

Advantages:

  • This breast surgery incision is not on the breast.

Disadvantages:

  • The scar can be noticeable when the patient raises their arm.
  • This breast surgery approach is found to be more likely to result in a bad positioning (especially when performed bluntly without endoscopic visualization).
  • Sometimes it is difficult to gain control of potential bleeding sources from this remote access.
  • It can be very difficult to use this incision for placing silicone breast implants.
  • Tattooing of the scar may be necessary to camouflage it better.

Transabdominal Breast Augmentation (TABA)

In rare cases, patients may be eligible for an incision in the upper abdomen, perhaps when combined with an abdominoplasty, or tummy tuck.

Advantages:

  • There are no incisions on or near the breast during this breast augmentation surgery.
  • There is usually good visualization of the pocket and bleeding points.
  • Because an adequately sized tunnel from the upper abdomen to the chest is created, saline or silicone breast implants can be placed through this incision.

Disadvantages:

  • This kind of breast augmentation surgery is only performed in women without significant ptosis (drooping) of the breast, and who also desire a full tummy tuck.

For more information on understanding a TABA, or help deciding if it is for you, visit our blog.

Transumbilical Breast Augmentation (TUBA)

Not often performed anymore, a transumbilical incision utilizes an incision in the belly button rather than one on the breasts.

Advantages:

  • There are no incisions on or near the breast during this breast augmentation surgery.

Disadvantages:

  • It is difficult to visualize the breast implant pocket for the plastic surgeon.
  • If there is any bleeding, an inframammary or periareolar incision needs to be performed to gain access for treatment.
  • Saline implants are the only type of implants that can be placed through this incision; therefore, silicone gel implants cannot be placed through this incision.

Breast Implant Placement Options

In general, there are two breast implant pocket locations Dr. Wallach uses during breast augmentation. One option is that the implants can be placed in a subglandular pocket, which is the space between the breast tissue and the underlying pectoralis muscle. Another placement option is submuscular, in which a pocket is created underneath that muscle.

Usually, in positioning breast implants in the subpectoral pocket, plastic surgeons part of the pectoralis muscle, which means the implant is not completely covered by the muscle. Usually, the muscle ends up covering approximately 50-70% of the implant with breast tissue covering the lower part of the implant. Dr. Wallach will help you understand how placement can affect your unique breast surgery outcome during a consultation.

For most patients that have little natural breast tissue, Dr. Wallach recommends a submuscular placement for breast augmentation surgery procedures. This is because the implant is usually more noticeable in without the muscle covering it due to a lack of adequate natural breast tissue coverage. The muscle adds another layer of tissue to camouflage the implant.

In addition, the submuscular placement is often favored because it is believed that the capsular contracture rate may be lower than a subglandular location. On the other hand, a subglandular pocket location is often preferred when there is adequate breast tissue volume.

Schedule Your Breast Augmentation Consultation

The decision to undergo cosmetic surgery is a complicated and intimate decision that is laden with procedural decisions that involve complex medical topics. Get clarity and peace of mind by talking with board-certified plastic surgeon Dr. Wallach at his practice in New York City to learn more about your options and how breast augmentation can give you the figure you’ve wanted. Don’t hesitate to schedule a consultation at our Manhattan offices at (212) 257-3263 or using our contact form to request an appointment.

Steven Wallach MD

Steven Wallach MD

Dr. Wallach is a board-certified plastic surgeon in New York City who specializes in performing cosmetic procedures of the face, breast and body. As one of the cutting edge experts in the field, Dr. Wallach consults on a regular basis with people in the beauty, media, and publishing worlds.

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