Surgical Approaches to Breast Augmentation

When deciding the type of surgical incision, it is important to remember that each patient's body is different. In addition, many surgeons tend to have more experience with one or two types of operations. This list should be used as an educational tool in helping you and your surgeon discuss the options available

Inframammary

This approach tends to be more direct and to allow greater control of the implant positioning. Seventy to eighty percent of breast augmentations are performed using this incision site. Since the incision is in the fold underneath the breast, the parts of the breast that make milk are less likely to be affected. This option also allows the surgeon to look directly where the implant will be placed and allows for better implant placement. In addition, if complications occur and additional surgeries are needed, the original incision can be used. Some of the other incision sites may not be ideal for treating complications.

This approach works well with patients who have already had children and are a little older, since age creates a small amount of natural sag in the breast. This minimal sag allows the incision to be well hidden in most women. For women who have yet to have children, who are thin, or who are younger, this surgical option may result in a more visible scar.

Trans-Axillary

This incision is from the armpit, or the axilla. Fifteen to twenty percent of breast augmentations are done using this surgery. This incision site can be used for both submuscular and subglandular placement of the implant. One of the advantages to this site is placement of the scar in a less visible location. It also allows better access to place the implant in the submuscular position. Some surgeons will also use an endoscope, or a small fiber-optic camera, to help them in this surgery. This approach is often used for thin women where submuscular placement would allow more natural appearance to the breast. It is also used for women who are younger and have little to no breast sag, thus making an inframammary scar more visible.

A potential disadvantage to this approach is that proper implant positioning is somewhat more difficult, particularly if the procedure is performed without and endoscope. In addition, if the patient experiences scar thickening postoperatively, this scar may be visible when the patient wears a shirt or dress without sleeves. In addition, it may be visible when the patient wears a bathing suit and raises her arms.

Trans-Umbilical Breast Augmentation (TUBA)

The incision and scar in this newer approach is through the belly button or umbilicus. A fiber-optic camera (endoscope) is tunneled from the umbilicus to a pocket under the breast. The implant is inserted through this tunnel into the breast and is then inflated with saline. It is important to note that using this incision, only sub-glandular placement is possible. Advantages of the TUBA include a less visible scar, less risk of nerve damage, and a faster recovery time. Disadvantages of this approach include a slight increase in the likelihood of damage to the implant, and the possibility of tunneling under one of the chest muscles (pectoralis major) during placement. Furthermore, complications that require additional surgeries for treatment may require a new incision closer to the breast. In addition, implant manufacturers frequently will not honor the implant warranty if the implant is placed through this approach.

Peri-Areolar

This is an incision around the nipple. The scar usually blends into the edge of the areola. However, since the incision lies closer to the parts of the breast that make milk, women with this type of breast augmentation often have more problems with breast feeding and nipple sensation following the surgery.

Where does the implant go?

The implant can be placed in one of two areas. When the implant is placed behind the breast tissue, this is referred to as "subglandular". Seventy-five percent of breast implants are placed in this position. When the implant is placed behind one of the surface chest muscles called the pectoralis major, this is referred to as "submuscular." The remaining twenty-five percent of implants are placed behind the muscle.

Advantages exist for both sites depending on the shape of the breast before surgery. Studies suggest that placing the implant behind the muscle decreases the risk of scar tissue contracture following the surgery, though submuscular placement is more painful than subglandular surgery. In addition, mammography is generally easier to perform with submuscular breast implantation. Submuscular placement is also recommended for smaller women, or women who want to greatly enlarge their breasts since this will often give better results. The subglandular surgery may give better results for women with sagging or droopy breasts and may be less painful.