Choosing Your Incision Placement

Options for Breast Augmentation Incisions

Around the Areola (Peri-Areolar):

Breast Incicsion ChoicesPlacing incisions around the areola is very popular with most surgeons. Your areola is the brown skin around your nipple (the part that sticks out).

Typically, these incision are made along the lower edge of the areola from the three to nine o’clock positions. I prefer to make them between the twelve and six o’clock positions to stay as far away from the sensory nerves that come around the side of the breast as I can. They only need to be slightly less than two inches long, so they can be anywhere from a third to half the circumference of the areola. These incisions need to reach the plane where the pocket for the implant will be made.

Can I still breastfeed?

A few, but by no means all of the breast ducts will be cut. This could theoretically impair your ability to breast feed. I hasten to add that I know of many women that have successfully breast fed after having had these incisions.

If the surgery is performed within a year of breast feeding, milk production may occur again, and the milk may leak through the incision. In this circumstance, you may want to either wait, pick another incision location, or take pills that your obstetrician can provide to dry up your milk. Milk ducts also contain small amounts of bacteria that are released by cutting through them. There are those that feel that this bacteria may increase the rate of capsular contracture. There is, as yet, no proof that this is the case, but no one will argue that this is a more invasive approach that alters, in a small way, the architecture of the breast.

These incisions usually heal very nicely into a white line along the areolar margin. I personally had these incisions, and they healed as well as any I have seen. I have had doctors examine me and not notice them, but I know they are there and see them whenever I look in the mirror.

Given the choice today, I would choose to have the incisions hidden beneath my breasts (the inframammary incision) where I would not see them. I mention this only as a personal observation.

Beneath the Breast (Inframammary):

These incisions are made in the fold beneath the breast. Often, the fold will drop slightly after surgery from the weight of the implant and stretch of the skin so that the scar ends up just above the fold. These incisions are usually about two inches long. I place these incisions a little to the side of the middle of each breast, where they will be the least conspicuous.

This approach is the least invasive of all the possible incisions. There is only a small amount of skin and fat to go through before you are in the right place to make the pocket for the implant. The breast tissue is not affected at all. These incisions usually heal quite nicely and are relatively inconspicuous.

Under the Arm (Transaxillary):

This is a popular approach for many patients because the incision is placed under the arm and not on the breast. They are my least favorite incisions for several reasons. Because the incision is away from the breast, it is more difficult to see what you are doing within the pocket. One of two approaches can be used. The more common is to do much of the operation “blindly.”

The initial incision and dissection is done under direct vision until the edge of the pectoralis muscle is located. Then a large blunt instrument is used to push through the tissues and create the pocket. The lower edge of the muscle is forcibly torn from its attachment to the ribs. Because this can result in bleeding, the pocket is often filled with cold water to constrict the blood vessels. It is also more difficult to get the lower inner aspect of the pocket shaped exactly the same on both sides.

The alternative approach to this method starts the same way, but when the edge of the muscle is reached, an endoscope is used with a cautery to dissect the pocket and cut through the muscle attachment to the ribs. The cautery is the instrument we use to seal off the ends of bleeding blood vessels. Most women have some sort of asymmetries or tissue characteristics that need to be dealt with that can be more difficult of even impossible to correct through a transaxillary approach. With the addition of the endoscope, the incisions must be made a little longer: about two and a half inches.

These incisions often heal well, but for some time, they are a nuisance to shave around and should not be covered with deodorants or antiperspirants. In my experience, it takes longer for women to feel comfortable raising their arms up over their head. Not infrequently, secondary surgery must be done through a different incision, resulting in more scars.

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