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Parlons des incisions

My patients often ask me about potential scars after their breast augmentation. Common questions include:
“Can people tell that I have had my breast enlarged based on scarring?” “Will they be able to see any scars?”
The answer is that it depends on scar location and how every individual scars. The good news is that there are a few different incision locations that you can choose from.

Most importantly, I should mention that everyone heals differently, and some patients will make better-looking scars than others. As for scar location, I believe that having direct and complete sight of the surgical area (the “pocket” where the implant is placed) is an important factor, which can influence your final result. Most surgeons will agree that a good visual of the pocket is highly beneficial; it allows me to place the implants safely and accurately, and to control small areas of bleeding that occur during the dissection. That being said, everyone’s anatomy is different and that is why I offer patients several incision options.

The more you know about breast augmentation, the better decision you and your surgeon can make as to which incision location suits you best.

So, here is a list of four different incision locations used in breast augmentation:

  1. The armpit (Trans-axillary)
  2. Around the edge of the areola (Peri-areolar)
  3. In the fold under the breast (Inframammary)
  4. Through the belly button (TUBA)

Incision #1: The armpit aka “trans-axillary”

This incision can be used in patients with smaller, perky breasts that do not droop at all. The scar is well-hidden within the armpit, and some patients prefer that there is no incision made on the actual breast. However, the choice of implants is quite limited with this approach. It is only possible to place saline or very small silicone implants via this incision. An additional challenge is the lack of direct visualization of the surgical area. This may be addressed with the use of an endoscope (mini camera), but in my opinion, further complicates the operation. Probably the biggest drawback to this incision is that touch-ups and future implant exchange can not be performed via a transaxillary incision…which means likely having a second scar some time in your future!

Incision #2: At the edge of the areola aka “peri-areolar”
The edge of the areola can act as natural scar camouflage due to the skin’s change in texture and color, but this does not mean that a scar will not be visible. While this incision allows for complete visualization of the pocket, the size of the areola dictates the size of implant that can be placed (in the case of silicone implants). Also, revisions can be performed via this incision, though it can be trickier than with the inframammary fold incision. There are also concerns that the proximity of this incision to the milk ducts can increase the risk of capsular contracture. (“hardening” of the implant caused by excessive scar tissue formation)

Incision #3: Through the belly button aka “TUBA”
In 1992, The TUBA was invented. This technique involves placement of a breast implant through an incision made in one’s belly button, with the assistance of an endoscopic camera. Only saline implants can be placed via this incision and the very long distance from the “pocket” makes this operation unnecessarily difficult and prone to error. Revisions cannot be made through the TUBA incision. Quite frankly, I don’t ever recommend this technique to my patients.

Incision #4: In the fold under the breast aka “inframammary”
The inframammary incision is the most popular and commonly used technique. It provides a full visual of the pocket (better than any of the other incisions!), leading to predictable implant position and effective control of bleeding. This incision can be reopened and used for any touch-ups or future implant exchanges. Also, any implant can be placed through the inframammary incision- including the latest cohesive gel or “gummy bear” implants. It is definitely the most versatile, predictable incision and happens to be well-hidden in the fold under the breast.

The take home message is: Every woman’s breasts and anatomy are different, and deciding on which incision to choose is a reflection of your individuality. Reading the available literature is an important way of educating yourself on your options. However, nothing replaces a consultation with a trusted plastic surgeon.

As a plastic surgeon who values his relationships with his patients, I know there isn’t a better feeling than working with a well-informed patient to make the best decision with them, not for them.

Feel free to ask me any questions regarding breast augmentation. I will be more than happy to help.

Dr Karl Schwarz