Breast Augmentation Choices

Incision Sites, Positioning, and Making the Right Decisions for Your Body

Breast augmentation, statistically, has been one of the most requested cosmetic surgeries in plastic surgery for many years. Women who seek breast augmentation generally fall into one of the following categories:

  • Women who have never had much breast tissue and want to fit clothing better or to feel more feminine.
  • Women who have lost volume during a pregnancy.
  • Women who have a developmental asymmetry of the breasts.
  • Women who have breast asymmetry from previous surgery.

A breast implant is simply intended to add volume to the existing breast tissue. It is NOT designed to change the basic shape of the breast or to lift the breast itself. If a breast lift is the goal then a different procedure would be necessary. In addition, a breast augmentation procedure will not give a patient more cleavage. Cleavage is determined by the width of the chest bone. Attempts to decrease this width and provide the patient with more cleavage may end badly. While a breast augmentation may add more volume to the breast itself, a push-up or push-in type bra is more advisable for creating cleavage. The breast is generally fully developed by the time the patient is eighteen years old. Patients under this age should be discouraged from seeking a breast augmentation. The breast may continue to change over the life span of the patient as a result of weight gain/loss, pregnancy, periods, etc. Breast implants are also not guaranteed to last a lifetime. Additional surgery may be required at some point to replace the implants or to improve the shape of the breast itself as it changes with time. Breast augmentation surgery can be performed through one of four possible incision sites: a single incision in the navel, incisions under the fold of the breast, incisions under the areolae, or incisions in the armpits. The advantages and disadvantages of each incision site are as follows:Trans-Umbilical Breast Augmentation (TUBA):

  • The incision site is hidden within the belly button.
  • Recovery is fastest with this approach.
  • There is less cutting involved and therefore less risk to the breast tissue or to the sensory nerve to the nipple.
  • Implants can be placed above or below the chest muscle via this approach.
  • Only saline implants can be used with this approach.
  • Precise development of the implant pocket is more difficult with this approach so that the risk of asymmetry may be higher.
  • Future surgeries may require a different incision site.

Inframammary:

  • The incisions are located in the natural folds under the breasts.
  • This is the easiest approach from the surgeon’s standpoint.
  • Implants can be placed above or below the chest muscle.
  • Saline or silicone gel implants may be used.
  • An underwire bra may rub and irritate the incision scar in this location.
  • If the patient wears a small bathing suit top and lifts her arms up, the incision scar may be exposed.

Infra-areolar:

  • The incisions are located under the areola on each breast.
  • Saline or silicone gel implants may be used.
  • Implants can be placed above or below the chest muscle.
  • The change between the color and texture of the skin and areola helps hide the scar.

Trans-axillary:

  • The incisions are located in the armpits.
  • Implants can be placed above or below the chest muscle.
  • Saline or silicone gel implants may be used.
  • There is less precision in development of the breast implant pocket and a greater risk of asymmetry.
  • If incisions do not heal well, they may be noticeable when the patient wears something sleeveless.
  • If the incisions do not heal well, they may interfere with shaving the armpit.

Additional potential complications associated with breast augmentation with any of the above incision sites may include:

  • Loss of sensation to the nipple or breast. The sensory nerves to the nipple/breast come from between the ribs. The risk of numbness or even super sensitivity is in the range of 2 – 10% of patients. Of these, statistically, 85% of patients will recover normal sensation within a year. Permanent losses are rare.
  • Capsular contracture. Patients are not born with implants. Since the body cannot reject the implants outright, it simply seals them off by forming a capsule made out of scar tissue around the implant. This is a normal occurrence. As long as the capsule remains thin, the patient should not notice it. If the capsule becomes thickened or tightens down, then the patient may require additional treatment to correct the situation.
  • Bleeding or infection. Fortunately, these are VERY rare occurrences, but may require additional treatment.
  • Breast feeding. While their breast tissue may change with a pregnancy, patients should be able to breast feed no matter which incision site is used.
  • Mammograms. Most mammographers have been dealing with breast implants for fifty years now. Mammograms are performed slightly differently for patients with breast implants than for patients who do not have them in order to visualize all of the breast tissue adequately. There is some suggestion in the literature that mammograms are easier to perform and interpret when the implants are placed under, rather than over, the chest muscle. In addition to the incision site, patients must also decide whether to place the implants above or below the chest muscle.

Advantages and disadvantages of each position include: Above the chest muscle:

  • This is where the breast tissue is located and therefore where the implant will behave most like breast tissue.
  • There is a higher risk of capsular contracture when the implant is located above the chest muscle. This may be due to increased bacteria in the breast tissue (and therefore increased risk of a subclinical infection) or the loss of the massaging action of the chest muscle gliding over the breast implant.
  • There is a greater incidence of rippling/wrinkling of the implant above the chest muscle.
  • Recovery is faster and less painful.

Below the chest muscle:

  • There is a decreased risk of capsular contracture since the muscle slides over the implant massaging it as the patient goes through her normal activities.
  • There is less chance of seeing/feeling ripples/wrinkles as the muscle adds another layer of coverage over the implants.
  • Flexing the chest muscle may cause the implants to move in an unnatural fashion. Over time, this may also cause the implants to migrate towards the armpits.
  • Muscle does not stretch as easily as breast tissue. It may take a longer time for the breast to drop and soften than it would if the implant were located above the chest muscle.
  • Recovery may be more uncomfortable due to the tension in the muscle.
  • If the breast tissue itself tends to sag over time, the implants may remain higher on the chest wall and not descend with the breast tissue.

Breast augmentation surgery is usually done under general anesthesia in an outpatient setting. Bandages are generally removed within a day or two. Some doctors use drains. These would also be removed in a few days at most. Patients recover at different rates but should expect discomfort for four to five days. Patients may resume non-strenuous activities when they feel like it. More strenuous activities should be avoided for at least three weeks following the surgery. Breast augmentation surgery can make a great difference in a patient’s self-image. In order to achieve the best possible outcome, the patient should seek out a plastic surgeon certified by the American Board of Plastic Surgery (ABPS), the only board recognized by the American Medical Association for the training and certification of plastic surgeons. The doctor should be willing to spend time with the patient answering any questions that she might have. She may also want to look at before/after pictures or talk with a previous patient about her experience. Breast augmentation surgery is a life changing event. It is important for a patient to do her research thoroughly with regard to the type of implant to be used, the incision site, and also the credentials and experience of the doctor performing the surgery. Dr. Win Pound is an expert in many areas of plastic surgery and is a world renowned expert in trans-umbilical breast augmentation (TUBA). Dr. Pound has performed the TUBA breast augmentation procedure more than any other plastic surgeon in the world. Contact his office for more information or to request a free consultation. http://www.winpound.com

Leave a Reply

Your email address will not be published. Required fields are marked *