Incisions in breast augmentation serve to get access to the plane under the breast gland or pectoralis major chest wall muscle where the pocket to hold the implant will be created. Factors such as patient preference, choice of implant, choice of plane and size and shape of the non augmented breast and areola influence the decision.
Three types of incisions are in widespread use: in the fold under the breast (inframammary fold), at the lower half of the nipple-areola complex, and in the hair bearing area of the arm pit.
The incision in the inframammary fold is in my opinion the most versatile and allows straightforward access to the plane under the breast gland (for subglandular augmentations) and the plane under the pectoralis major muscle (for subpectoral or dual plane augmentations). It is the most reliable way to place silicone gel implants, especially if larger implants are desired. An about 5cm incision is required to place an average size e. g. 325ml silicone gel impant. Saline implants, which are inserted while deflated, can be done through a 4cm incision as a minimum. In either instance, visibility, control of the pocket dissection and precision are excellent with correct instrumentation. The only real contraindication to using this incision is a “small augmentation” in a small breast with an insufficiently developed inframammary fold. In this instance the resulting scar is not well hidden and an alternative incision should be selected.
The second most common incision in my practice is in the arm pit. I use it only for saline implants and only for subpectoral augmentations. The resulting scars are generally imperceptible even in darker skinned clients. Unless endoscopic equipment is used for the dissection, control and precision are not as favorable as in inframammary approaches.
The so called periareolar incision is suitable for placing either saline or silicone implants in subglandular or subpectoral pockets. If the circumference of the areola is smaller than 9cm placement of silicone implants becomes tedious and traumatic for both the patient’s tissues and the implant. Resulting scars at the transition from the darker pigmented areola tot he skin are generally imperceptible. Dissection and approach to the pocket plane are not as direct as in an inframammary approach. It is an ideal incision if any reshaping needs to be performed at the inferior pole of the breast as in may be the case for mild tubular breast deformities.
Experimental approaches such as “incision-less approaches” using transfers of the patients own fat into the breast for augmentation replace one incision with several small stabs in the skin to introduce the cannulas to inject fat.
The trade-offs involved in selecting an incision are an important part of the preoperative consultation and counseling process.