In this article I will be discussing the pros and cons of the different types of incisions done for breast augmentation. Plastic surgeons in San Francisco perform many cosmetic surgeries and breast augmentation is one of the most frequent.
The primary reason for concern with this is because a scar will remain at the site of the incision. Whenever there is an incision made through the skin, a scar will result. The amount of scarring is related to a number of issues that include, surgical skill of the physician, location of the incision, presence of post surgical infection, and the patient’s propensity to form scars.
As a rule, surgeons use one of four locations for insertion of breast implants. These four locations are the axilla (arm pit), infra-mammary fold, areolar border, and the umbilicus (navel). There are pluses and minuses to each area. It is very beneficial for the patient to be aware of this and other issues before consulting a physician. The final decision will be made after discussing it with your physician.
Generally when inserting a breast implant, an incision of one to one and a half inches is required. The exception to this is the T.U.B.A. incision. Other factors that influence the length of the incision are the surgeons skill, type of implant, size of implant, and texture of the implant. Saline implants are filled after insertion therefore they are smaller when inserted. A silicone implant or an implant with a textured surface will normally need a little larger incision.
The areolar approach is performed by making an incision at the lower border of the light and dark skin of the areola in a semicircular shape. Often a protective sleeve is used when inserting the implant to prevent injury to the breast ducts. If a mastopexy (breast lift) is being performed at the same time, this would be the approach of choice because the mastopexy also requires an incision in the same place. The areolar incision usually results in an excellent cosmetic appearance. Disadvantages of the areolar incision possibly include a more noticeable scar if healing does not go well. There is also a slightly higher risk of altered nipple sensation following this procedure.
Breast implants can also be inserted with an infra-mammary incision. The incision is usually just above the crease where the bottom of the breast meets the chest wall. This is the most often used technique for breast augmentation. This like the areolar incision is a location that makes it easy for the surgeon to position the implant. A benefit to this location is the ability to reuse the same area if there is a need for revision in the future.
The trans-axillary incision is placed in the arm pit. Once the incision is made, the surgeon can then create a channel to the area where the implant will be located. The implant is then moved into place usually with an endoscope (a flexible tube shaped device with a fiber optic camera). The biggest advantage to this technique is that there will be no scar on the breast when completed. A disadvantage to this approach is that future revisions will require an incision at a different location.
The Trans-Umbilical Breast Augmentation or T.U.B.A. incision is done by creating a small incision at the navel. An endoscope is then used to tunnel up to the breast area, going through subcutaneous fat, just under the skin. This tunnel is used to pass a rolled up saline implant up to the chest area. The implant is unrolled and filled with saline. The T.U.B.A. procedure leaves no scars on the breasts. However, “tracks” may form where the tunneling was done. These usually disappear with time but not always. Silicone implants may not be used with this technique.
Your final choice will be made with your physician, and will be determined by your choice of silicone or saline implants, the size of the implants, and other individual issues. Please remember to choose a board certified plastic surgeon when you consult a physician regarding your breast augmentation.
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