Types of Surgical Procedures for Breast Implants

Choosing where you want your surgical incision to be placed for breast implant surgery is not always an easy decision to make. Sometimes it depends on the surgeon's preference or ability as well as your particular needs or desires as a patient. For example, having a textured implant can be a little more difficult to place with a smaller, endoscopic incision of, say, an inch to an inch and a half, depending upon the size of the implant. Although the minute imperfections of a textured implant are nominal it can rough up the edges of an incision resulting in a slightly more jagged scar and possibly transmittal of surface bacteria to the implant.

But this is a rare occurrence. Smooth surfaced implants can easily be placed within an incision of an inch in length on the breast and even smaller through your navel as the elasticity is more pronounced in the abdominal area.

If you are getting very large implants and your skin is not so elastic you may need a TUBA or trans-axillary approach so that the force exerted by the larger implants (even with gradual filling) will not be so severe on the healing incision. Infra-mammary and Peri-areolar incisions may stretch more resulting in a widened scar if the augmentation is substantial. Even worse, if your natural crease (where your breast meets your chest underneath) needs to be lowered either surgically or by force as well (i.e. the STRAP), the infra-mammary scar may ride up higher on to the breast if the surgeon does not accurately predict the new crease location or if the crease moves lower, faster than expected.

This may also be true with a Mastopexy (breast lift) or areolae reduction with augmentation. If you are getting the lift and/or areola reduction with implants the increased pressure on the now tightened skin can force the scar to widen and/or elongate. Normally, paper tape such as Steri-Strips (3M Corp) will be used to help with any scar widening, flattening and healing in general. Steri-Strips provide an enhanced and hastened maturation as well as flattening and support of the incision lines, usually resulting in better scarring.

Implant Insertion and Position
The method of inserting and positioning your implant will depend on your anatomy and your surgeon's recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.

 

Transaxillary (Underarm)

This particular incision (the one I personally chose for myself) offers a scarless breast. The incision site is in the armpit, in the natural "folds" of skin, making it well-hidden. Mine have healed beautifully, and I'm very happy with my decision to have the transaxillary incision. Should the scars not heal as nicely as you expect, chances are, most people won't associate scars in the armpit area with breast surgery of any kind. Most people don't pay that much attention to this area anyway.

Many believe that placing implants via this incision is not possible with out the use of an endoscope. This is not so. If you have an experienced, skilled surgeon, it can most certainly be done. But, if your surgeon isn't skilled at placing them "blindly", you run the risk of having implants that are lopsided. Some surgeons feel that the endoscope offers no perceivable benefit. However, this is based on their own experiences, and is an opinion, not a fact.

As with the TUBA method, the transaxillary incision means that the surgeon will be working farther away from the breast, which is more difficult. Again, finding a surgeon that has experience in this procedure is a must.

Breast implants can be placed over the muscle, partially underneath the muscle, or completely behind the muscle/fascia with this incision.

The downside to the transaxillary incision is that if a complication occurs, and you need to have another surgery, chances are, you'll wind up getting a different incision. Some surgeries are just too difficult to perform via the transax incision. Some examples are bottoming out surgery, symmastia, and capsulectomy. A capsulectomy can be performed via the armpit, but is more difficult.