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A Breast Augmentation consultation can be overwhelming. There are so many factors you and your Plastic Surgeon must consider--Implant size, profile, pocket and now incision too?? The good news is, it’s not all that complicated and t
here is usually more than one “right” answer. I believe the most important thing is to fully understand the benefits and limitations of each so you can make the right decision for you and your body. There are 3 popular incisions and each can be used to place an implant either above or below the muscle. The most popular incision is placed at the crease of your breast (in the Inframammary Fold), followed by a Periareolar incision (around the areola) and Transaxillary (in the armpit). No matter the incision, all are meant to be hidden. So which one is best? That depends on the patient, their anatomy, and on the surgeon.
Patient Factors to Consider:
For the patient, you want to consider a few things before making this decision with your Plastic Surgeon. First off, where do you want an incision? Sure, everyone wants a scarless procedure but, well, they don't exist. Consider the clothes you typically wear and the activities you do. For example, are you a yoga fanatic who constantly has your arms in the air while wearing a tank top? Ok, well then an armpit incision will likely be most visible in you and probably isn’t a great option.
Patient Anatomic Features:
Anatomy is key in helping to guide every decision we as Plastic Surgeons make in our surgical planning. Considerations of your anatomy will include the presence of a Tubular Breast deformity (stay tuned for another blog post about this!), your nipple position and if there is any breast skin or tissue hanging below the breast fold (a term we call ‘pseudoptosis’). A Tubular Breast deformity is best approached through a periareolar incision, since the areolar size is often reduced simultaneously during an Augmentation. With a low nipple position and pseudoptosis, some surgeons may choose a Dual Plane approach (also a future blog post!) that may require an Inframammary approach.
Surgeon Considerations:
In Plastic Surgery, there is usually more than one way to achieve a great result. Every surgeon over time will develop a technique or approach to different cosmetic procedures that works great in their own hands and produces the results they desire. There is a good reason you chose your surgeon in the first place (hopefully!). Presumably, you like the results you have seen from your surgeon and you trust them. That doesn’t mean you just blindly do anything your surgeon tells you to do, but you should trust their decision making process if they are the right surgeon for you. Your surgeon should, however, be able to clearly and concisely articulate to you the ‘why’ behind their recommendations. Be wary of the surgeon who can’t explain themselves AND who uses the exact same approach on every patient.
The Science:
While I believe the above factors are the most important for you and your Plastic Surgeon to consider, it must also be said that studies consistently show higher rates of Capsular Contracture in both the Transaxillary and Periareolar approaches. That doesn’t mean they aren’t totally acceptable approaches, but as with everything in Plastic Surgery, there is always a risk vs. reward balance to consider.
Dr. Megan Dreveskracht is a Seattle-based Female Plastic Surgeon who specializes in Aesthetic Surgeries of the Breast, Body & Face. To schedule your consultation, call 206.860.5582 or fill out a contact form here.