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What is the best incision for implant-based breast augmentation?

Updated: Aug 4


Among the myriad aesthetic surgical procedures, few captivates women quite like breast augmentation with implants. The American Society of Plastic Surgery's statistics reveal it as one of the most sought after procedures. In this transformative process, a plethora of crucial decisions awaits, including the choice of implant type, size, and placement (above or below the muscle). Yet, one question inevitably emerges during every consultation: "What is the best incision?"


There is no simple or universal answer to this question and what works for a lady may not be the best option for another. In this blog post, we explore the different incision techniques and compare their advantages and limitations.


There are three commonly-used options for incisions: inframammary fold, axillary (armpit), and periareolar. In recent years, some centres also advocate the use of periumbilical (belly button) incisions and we shall briefly discuss this approach as well.


Inframammary Fold Incision:


The inframammary fold (IMF) incision is a time-tested, traditional approach favored by many plastic surgeons. It involves creating a discreet, small incision in the fold underneath the breast. This technique allows best exposure for precise implant placement, making it easier for the surgeon to control the implant's position and adjust it for optimal symmetry and projection. In my experience, this incision is best performed with larger implants so that the resultant scar is more "downward-facing" than "forward-facing". Patients with scar tendancy should avoid this incision as it is least concealed among the four options. However, if a complicated revision surgery is expected, this incision may be preferred due to better exposure that allows more control and precision in implant placement.


Transaxillary Incision:


This technique involves creating an incision in the armpit, through which the surgeon skillfully tunnels the implant into place behind the breast tissue. This procedure is often performed with the endoscopic guidance. The main advantage of this incision method is that it leaves no visible scarring on the breasts themselves. The main limitation of this approach is that the surgeon cannot directly visualize or feel the breast tissue, resulting in less control and precision when placing the implant. In addition, the armpit scar may also be visible when wearing sleeveless tops and can make shaving more difficult. It should be noted that this scar can rarely be reused for future revision / implant removal surgeries.


Periareolar Incision:


The Periareolar Incision technique entails creating a carefully positioned incision around the areola, typically situated on its lower half. Through this discreet opening, the surgeon inserts the implant, meticulously placing it in its designated position.


This approach boasts numerous advantages. Firstly, the resultant scars are generally well-concealed and blends harmoniously with the natural border between the darker areola and surrounding skin. With clothing on, the scar remains virtually invisible. Moreover, the central location of the incision allows the surgeon to achieve precise implant positioning, enhancing the overall aesthetic outcome. Another advantage is that any future breast surgeries can be conducted using the same opening, reducing the risk of additional scarring. This technique is particularly suitable for patients with larger areola and thus often used in parous women.


However, like any technique, this procedure also comes with certain drawbacks. It may not be suitable for patients with very small areolas. There may also be a change in nipple sensation, potentially affecting sexual pleasure and future breast feeding. In the unlikely scenario that the milk ducts are severed, it may also complicate future breastfeeding.


Transumbilical Incision:


Transumbilical Breast Augmentation (TUBA) is infrequently performed compared to the three other approaches. Transumbilical incisions involve creating small openings on the upper-inside edge of your belly button. Through these openings, deflated implants are carefully maneuvered up to the breasts and positioned. Once in place, the implants are then inflated to achieve the desired size.


The primary and most apparent benefit of the transumbilical incision is the concealed scar, discreetly hidden within the navel, making it virtually invisible. However, there are several drawbacks with this approach. Firstly, the considerable distance from the breasts adds challenges to precise implant positioning. Secondly and importantly, the implants cannot be filled until after they have been inserted, which significantly limits the patient's choices of implants. Majority of the common used silicone (and saline) implants cannot be used. Also, similar to the transaxillary scar, the TUBA scar cannot be reopened for revision surgery in the future. If the breasts require additional work, this means more scars will be added, potentially compromising the aesthetic outcome.


Conclusion:


In the realm of implant breast augmentation, the choice of incision technique is a crucial decision that should be made in consultation with a skilled and experienced plastic surgeon. Each incision method offers its own set of benefits and considerations, from discreet scarring to precise implant positioning. Ultimately, the ideal technique will vary depending on individual factors such as body type, breast anatomy, and desired outcomes.


If none of this is deemed suitable or acceptable, one may also consider breast augmentation with fat-grafting.


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