Breast Implant Surgery – The Pros and Cons of the 4 Incisions

Breast Implant Surgery – The Pros and Cons of the Four Incisions

Hello. My name is Adrian Richards, and today I’m going to be talking about the different types of incisions used for breast augmentation surgery. Now you may have read about this, but essentially there are four places the implant can be inserted. Number one is through the tummy button. Number two is through the crease underneath the breast. Number three is underneath the nipple and number four is the armpit. Let’s work up from the bottom and then talk about the pros and cons of each.

Through the tummy button is only really used for saline implants which can be completely collapsed and inserted through a very small incision. Whereas this type of insertion site seems very attractive, you can only use saline which is salty water filled implants which have problems, potentially more rippling and deflation. So in England, we tend not to use that approach. I’m not aware of any surgeons in England who use the tummy button approach principally because it’s very difficult to accurately place the implant.

The second incision, which is probably the most common in England, is an incision in the fold underneath the breast. This is most commonly used because the surgeon can accurately place where the implant’s going to go and can actually raise or lower the fold underneath the breast. In many people, you need to lower the fold slightly beneath the breast to give a nice gentle curve to the lower part of the breast. This incision is typically five centimetres long, located slightly offset of the midline in the fold. When it heals, it’s very difficult to see because it’s hidden in the natural contour.

Third type of incision is around the areola. The areola is the brown area around the nipple, and typically this incision is on the junction of the areola and the breast skin. Now, quite an attractive approach. Not good for people with small areolas because you need a five centimetre incision to get the implant in without damaging it. If you’ve got a small areola, perhaps it’s not suitable. There is also a slightly higher risk of infection because of the secretions from the nipple and also altered sensation to the nipple which puts off many people.

The fourth approach is through the armpit or the axillary approach. This has some advantages. It’s slightly more difficult to get the implant in exactly the right position. Because of the location of the incision, these implants are normally put under the muscle, so, totally under the muscle. The problem with this approach is there’s a slightly higher risk of infection because of going through the armpit. You can get altered sensation down the inner aspect of the arm because there are some very important nerves travelling from the chest to the arm which go through that area. Probably the biggest downside of that particular incision is that it’s difficult for the surgeon to accurately get the implants at exactly the same height because it’s quite a way down to the pocket created.

Just to summarise, there are four types of incisions. Tummy button incisions are not really used in England. Armpit incisions are probably used in about 10% of cases in people who like the idea of an implant under the muscle. The main incisions used in England would be the areola incision, probably used in about 20% to 30% of cases. The vast majority of patients have implants inserted via the fold, with the incision concealed in the fold, and probably 60% to 70% of patients in the UK have the implant inserted that way.

The important thing is really to talk to your surgeon. Really think about which way you’d like it inserted, which sort of scar is best for you. Look at some pictures of patients who’ve had both approaches which the surgeon should be able to give you. Have a frank and open discussion with the surgeon about the options.

Thank you.