Incision Sites

The implant can be inserted into the body through four different incision sites. Two leave scars on the breast, while the other two leave scars away from the breast. Because the implant is inserted empty, all of the incisions are small, generally measuring less than one inch. The physician will lift the breast tissue and create a pocket for the implant either behind the muscle or behind the breast tissue. Sometimes an endoscope is used. The method one chooses will depend on ones anatomy, expectations, breast condition, implant placement and physicians recommendations.

Inframammary

The inframammary incision is the most common technique used. The cut is made on the underside of the breast at the inframammary fold, where the crease of the breast meets the chest. Placements above and below the muscle can be done this way as well as any future implant replacements or revisions. Many surgeons prefer this method because it allows for great control of final implant placement. The main disadvantage is a visible scar in the breast area. Also, recovery can be longer and more painful than with some other methods. It should be noted that if a patient chooses to go with bigger or smaller implants on subsequent surgeries the initial scar will be placed differently on the breast. It might not be as concealed. For example, a once hidden scar may creep up on the breast if the breast is enlarged.

Periareolar

The periareolar incision is made on the lower edge of the areola. This is the dark circle around the nipple, not the nipple itself. In most cases, it is the most concealed incision and the scars tend to heal well. All placements can be done this way including revision surgery. Moreover, physicians have desired control over implant placement with this incision. If one is considering a breast lift, this is the incision to opt for because the same opening can be used for both procedures. There is no other alternative for breast lift incisions. There are some disadvantages to periareolar incisions as well. For example, since the scar is located right on the breast, if there is any complication with the scar such as deformity, redness, or swelling, it will be more visible. This incision has also been associated with a greater inability to breastfeed. Generally the periareolar cut does not cause any less sensation than the others, but women with smaller areolas may notice it more because the incision might extend past the areola. Also, one is more likely to be exposed to the natural bacteria found in breast tissue with this incision. Thus it is necessary for the surgeon to use a protective sleeve around the implant so it will not be contaminated by the bacteria in the breast ducts.

Axillary

This incision site is located in each armpit. With this method, most likely an endoscope will be used although some skilled surgeons opt not to use it. It depends on the surgeon and his/her experience. One obvious advantage of the axillary incision is that the scars are tucked away in the natural folds of the armpit leaving a scarless breast. As with the other afore mentioned incisions, all placements can be done this way. However, unlike the other two, the possible revision surgeries will require another incision site; thus leaving more scarring. The doctor will also be working away from the breast which may impede proper placement of the implant.

Transumbilical (TUBA)

With this method, the implant is inserted through the belly button. Like the axillary incision, an endoscope is used to tunnel from the stomach muscles, through the subcutaneous fat, up to the breast. The endoscope is removed and the implant is rolled up and slipped through the tunnel. The implants are filled with a syringe through the belly button. This method is the newest procedure being used and is currently the least common. Because it is so uncommon,iIt is difficult to find a skilled, experienced surgeon with this technique. The advantages to a TUBA incision are as follows: There is a faster recovery because there is very little tissue trauma. The sensory nerves of the nipple and breast are less likely to be harmed or affected. The entire operation takes only 30-45 minutes which is less than the other three methods. And finally, there is only one incision on the rim of the belly button that is potentially smaller than the others due to the elasticity of the skin of the stomach. The main disadvantage is if further surgery is required, the surgeon will have to enter through one of the afore mentioned locations anyway thus creating more scars. A temporary problem is that firmness of the abdominal tunnels created during surgery may be noticeable. However, this can be remedied over time with massage. Although the implants can be placed under the muscle with this method, it is much more difficult and less common. Many doctors contend that poor placement is more likely with a transumbilical placement. This method may not be endorsed by the manufacturers of your implants. This could negate any product warranty. There is no quantitative research that can associate loss of nipple or breast sensation to a particular incision site. Implant size and surgical technique may have more to do with decreased sensation than incision location. Remember, there is no one right incision site. It is up to each patient to decide which one is best for her.