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Dr. Motykie's Practice | Dircetions and Location

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Incision Location

Breast Implants | Breast Augmentation Beverly Hills | Los Angeles

There are different advantages/disadvantages for each incision location. In general the incision should be no longer than an inch although it may be slightly longer for placement of silicone gel-filled implants. There are four common incision sites for insertion of breast implants: under the arm/armpits (axillary), beneath the areola (peri-areolar), in the breast fold (inframammary) and through the belly button (transumbilical).

Peri-Areolar Incision: This is generally the incision of choice for highly-experienced surgeons for breast augmentation surgery since it offers a variety of major advantages.  To begin with, the peri-areolar incision offers the most complete access to the breast pocket which allows for more precise pocket modification and the achievement of excellent breast pocket shape, symmetry and creation of cleavage. In addition, the peri-areolar incision allows for the option to lower the breast fold (perform the dual plane technique) as well as perform several unique concurrent mastopexy techniques. The peri-areolar technique also allows for concurrent breast reshaping in cases of breast asymmetry and deformity (tubular and constricted breasts) and it is the incision of choice for revision breast surgery procedures. Furthermore, the breast pocket can be developed under direct vision allowing less risk of bleeding and improved avoidance of nerves (preserve nipple sensation). The scar from the peri-areolar approach is amongst the best since the incision is strategically placed along the border of the pink/brown pigmented areola. Because there is a change in color/pigment between the skin and the areola in this location, the scar is well camouflaged in this “border” region allowing it to become nearly imperceptible in many cases. Overall, it seems to be common sense that breast surgery is best done “thru” the breast and the peri-areolar technique allows for a quick recovery from surgery, the most accurate breast shaping, the performance of the dual plane technique, a low risk of nipple sensory changes and the creation of natural, beautiful appearing breasts. Both saline or silicone gel-filled breast implants can be inserted through this incision and the only true contraindication to this technique is a patient with very small areolas.

Inframammary Incision: An inframammary incision (breast crease or fold incision) is placed in the breast crease/fold where the breast and chest come together (This crease is called the inframammary fold). The inframammary fold is created by gravity’s pull on the lower portion of the breast where the breast and the skin come together (normally in the location of the fifth or sixth rib). The surgeon selects the location to place the incision near the inframammary fold in order to allow proper placement of the implant and reduced scar visibility. A properly located inframammary incision should typically be easily hidden under a swimsuit top although the incision is less concealed than the periareolar incision since it may ride-up onto the breast mound with time.  The inframammary incision allows the surgeon to work close to the breast, which gives adequate visibility of the breast pocket during surgery. It should be said that this was the original technique described for placement of subglandular implants and it has since been grandfathered in as an appropriate approach for breast augmentation. This is the technique that is typically taught to all “beginner” surgeons during training/residency programs and it is sometimes felt to be outdated due to the development of more modern techniques such as the dual plane approaches to breast augmentation. The inframammary incision is also not as versatile as the peri-areolar incision which allows for possible concurrent breast lifting and reshaping techniques.

Transaxillary Incision: A transaxillary incision is placed in the natural folds of the skin in the armpit. When lying down, the armpit is immediately below the breast. To perform the transaxillary approach, an incision is made in the natural folds of the armpit tissue and a channel is created through the armpit and into the breast. This procedure is sometimes performed with an endoscope (a small tube with a surgical light and camera embedded in the end) to provide visibility through the channel. The biggest advantage with the transaxillary incision is that the scar is not on the breast. This approach can be used to place the implant above or under the muscle. The transaxillary incision is less concealed than the periareolar incision and less pocket visibility (even with endoscopic equipment) can lead to an increased risk of implant malposition and asymmetry. In addition, the transaxillary approach may have an increased risk of nipple sensation changes and the creation of “wide” cleavage. Due to the length of dissection and the proximity to the chest muscle insertion, there is a longer recovery period than some of the other approaches to breast augmentation and some patients have difficulty/tenderness raising their arms for a period of time after surgery.

Transumbilical Incision: A transumbilical breast augmentation (TUBA, belly button) incision is made on the rim of the belly button and a tunnel is then made under the skin all the way to the breast. After the pocket is created in the breast utilizing an inflatable balloon, the implant is inserted through a long metal tube and pushed up into the breast area. After insertion, the implant is then centered as best as possible behind the nipple. This procedure is considered a completely blind procedure that offers a surgeon little control of pocket shape, cleavage and symmetry. This is because, compared to the peri-areola and inframammary techniques where the incisions are in the immediate breast area, the surgeon is working far away from the breast which provides low pocket visibility and diminished pocket sculpting ability. This distance makes the procedure more difficult and leads to a decreased ability to shape the breast and avoid pitfalls. Also, this is the only incision that does not allow for possible placement of silicone implants since pre-filled silicone gel implants cannot be pushed through the narrow tube used to place the implants in the breast pocket.  In addition, any subsequent surgeries that may be necessary to correct/repair problems arising from the TUBA approach will require a second incision placed elsewhere on the breast since the TUBA technique does not allow for performance of revision surgery to adjust for breast asymmetry, tubular deformity or correction of any degree of pre-operative breast sagginess. Lastly, this procedure should not be performed in very thin patients or patients with abdominal scars or hernias.

Remember, although it is tempting to select an incision based solely on the level of scarring in the breast area, it is far more critical to choose an approach that allows for optimum breast shaping in your own individual situation while minimizing the possible need for revision surgery at some later point in time.

To find out more about breast augmentation please contact us at 310-246-2355


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Dr. Gary Motykie