Breast Implant Incision Options

Areolar

This incision is created along the bottom edge of the areola. The scar often blends in completely, so it's a discreet option that's very popular among our Houston clients.

The areola is the pigmented area around the nipple. Also called a periareolar incision, it follows the curve that separates the darker skin of the areola from the remainder of the breast. Through the incision, a pocket is created, either inside the breast or beneath the muscle tissue, into which our plastic surgeon inserts the implant. The implant is then positioned so it is centered in the pocket, behind the nipple.

What are the advantages of a periareolar incision?

There are several advantages to a periareolar incision, including:

The potential for the scar to be virtually invisible, because of its position against the darker area of skin.
Because the incision is so close to where the implant will be located, the placement of the implant is very precise.
Also, due to the incision’s location, it is very easy for your plastic surgeon to control any bleeding.
Unlike other types of incisions for breast augmentation in Houston, a periareolar incision can be opened again for future breast surgeries, such as implant replacement, as implants must be replaced after a specific number of years. Repositioning or removal of the implant can be performed simply with this incision.
The periareolar incision can be used with any type of implant or as the incision of choice for a breast lift, when the breast tissue is lifted and reshaped without placing implants.

What are the disadvantages of a periareolar incision?

The formation of scar tissue is the body's natural response to the placement of any foreign object, such as an implant. There is no 100 percent guarantee that an incision will heal smoothly. This is dependent on many factors, having nothing to do with the surgical technique used or the skill of the surgeon performing the surgery. It may be a matter of how well an individual patient heals or how carefully a patient follows post-operative instructions. If it does not heal as expected, it may be more obvious than would be considered desirable. This could manifest as a raised area or as lighter in color than the areola.
Because the incision is made in the breast itself, a periareolar incision is more likely to sever nerves in the nipple or, potentially, milk ducts. The severing of nerves can lead to a loss of sensation in the breast, and the severing of milk ducts can lead to difficulties in breastfeeding.
A capsule will form around any type of breast implant. However, in some cases, internal hard scar tissue may tighten or contract. When it restricts the movement of the implant, it is called “capsular contracture.” It is sometimes due to bacteria reaching the implant and may result in the breast feeling painful and stiff and becoming misshapen. The risk of capsular contracture for inflatable implants, which can be rolled up and put into a sleeve, may be reduced if the surgeon uses a protective sleeve during insertion.

Who is a candidate for periareolar breast augmentation?

As with any elective surgery, a good candidate for periareolar breast augmentation should:

Be in good general health. Patients with autoimmune disorders, diabetes, cancer, heart problems or high blood pressure are not generally considered good candidates.
Be a non-smoker, as smoking impedes wound healing. However, if you are a smoker, in your consultation, discuss the possibility of quitting for the two to four weeks prior to surgery. In some cases, this may be adequate.
Be free of medical conditions that reduce wound healing.
Have a good general outlook on life and realistic expectations for the surgery.
A periareolar incision may interfere with breastfeeding. This, as well as any other possible risks will be thoroughly discussed during your consultation. However, if you are still in your child-bearing years and plan on getting pregnant in the future, this is an important consideration.

Inframammary

This approach involves an incision near the crease beneath the breasts, slightly above where the breast and rib cage meet. It's a very common and effective technique, and often the appropriate method for placing silicone breast implants.

This incision creates a pocket into which our plastic surgeon will insert the implant. The implant is inserted either above or below the muscle. The implant will then be centered in the pocket, behind the nipple.

What are the advantages of an inframammary incision?

There are several advantages to an inframammary incision, including the following:

Any scarring can be easily hidden under the top of a bathing suit or bra, with the scar hidden by the breast itself.
Its position allows the implant to be placed in any one of the three implant locations (see below).
Because the incision is so close to the breast and where the implant will be located, there is a great deal of visibility of the area being worked on during the surgery.
Also, because of the incision’s location, it is very easy for your plastic surgeon to control the bleeding.
An inframammary incision can be opened again and used for other surgeries on the breast. This makes repositioning or removal of implants far easier.
Because of its placement below the breast, there is no risk of severing nerves or milk ducts, as is a slight risk in a periareolar incision for breast augmentation surgery.

What are the disadvantages of an inframammary incision?

Although the inframammary incision can be reopened for repositioning or removal of an implant, it may create a problem if a change in the size of the breast implant is desired. If larger implants are inserted, the scar may move up on the breasts, where it may become more visible. If smaller implants are inserted, the scar may become visible beneath the fold of the breast.

The Three Implant Locations

During your consultation, your doctor will discuss the pros and cons of each for your particular situation.

The three implant locations are as follows:

Subglandular

In subglandular breast augmentation surgery, the implant is positioned behind the breast, but in front of the muscles and fibrous tissues that line the front of the ribs and the wall of the chest.

Partial Submuscular

In partial submuscular breast augmentation surgery, the implant is positioned only partially under the pectoral and other chest muscles; the remainder being positioned behind the breast tissue.

Full Submuscular

In full submuscular breast augmentation surgery, the implant is positioned behind the breast, as well as all the muscles in the chest. The pectoral muscles, therefore, provide a constant source of massage, which some surgeons believe helps to inhibit the development of a condition called “capsular contracture.” Capsular contracture, the tightening of scar tissue around the implant, can lead to pain and stiffness in the breast, as well as the breast becoming misshapen. This technique is the most demanding to learn, requiring a greater level of training and skill. If you are considering full submuscular placement of implants as an option, along with ensuring that your doctor is a board-certified plastic surgeon, it is imperative that your surgeon is familiar with this more advanced surgical procedure.

Who is a candidate for inframammary breast augmentation?

As with any elective surgery, a good candidate for inframammary breast augmentation should:

Be healthy. If you suffer from an autoimmune disorder, or conditions such as diabetes, cancer, heart problems or high blood pressure, you may not be a candidate for this surgery.
Non-smoker. Smoking negatively impacts the body’s healing processes. If you currently smoke, surgery may be approved if you fully quit for several weeks prior to undergoing surgery.
Do not have a medical condition that affects the body’s ability to heal.
Have a positive attitude, are well-informed, and have realistic expectations.

Transaxillary

A transaxillary incision is hidden in the armpit. Through that opening, an empty saline implant can be inserted. Once placed, it is then filled to the desired size.

The Two Techniques for Transaxillary Breast Augmentation Surgery

Transaxillary breast augmentation surgery can be performed in two ways:

The Endoscopic Method: An endoscope is a tiny camera that fits onto a tube and has a light at the end of it. The camera is inserted through the incision, into the pocket made by the surgeon, and the images are shown, magnified, on a large monitor. This affords the surgeon a high level of visibility into the area
The “Blind” Method: Surgery is performed without the use of an endoscope.

The method chosen is based on your doctor’s preference. It is a more difficult surgery than either the periareolar or inframammary, as the incision is farther from the breast, so it is important to choose a plastic surgeon highly experienced in this method.

What are the advantages of a transaxillary incision?

There are several advantages to a transaxillary incision, including the following:

Typically, the armpit area tends to heal very well. Additionally, since the incision is made in the armpit, scarring is not visible.
Its position allows the implant to be placed in any one of the three implant locations: over the muscle, partially under the muscle or completely beneath the muscle.
No cutting of the muscle is necessary, if the muscle is lifted and the implants are positioned beneath it, which can assist in an easier recovery.
The implants do not come in contact with the milk ducts. This reduces the risk of contamination, since the milk ducts can harbor bacteria. It also avoids the risk of severing of milk ducts, with no interference in plans to breastfeed a baby in the future.
While both prefilled (gel) and inflatable (saline) implants can be inserted, doctors usually opt for inflatable. This means that a “custom” amount of saline can be injected into the implant, resulting in the exact size desired.

The risks of both nerve damage and lack of symmetry after implant placement are, of course, minimized when you choose our board-certified plastic surgeon, highly experienced in performing the transaxillary technique.

Who is a candidate for transaxillary breast augmentation?

As with any elective surgery, a good candidate for transaxillary breast augmentation should:

You must be in good general health. Those who suffer from autoimmune disorders, diabetes, cancer, heart problems or have high blood pressure are at higher risk of complications from surgery.
Be a non-smoker, as smoking can slow or cause problems with wound healing. If you are currently a smoker, to undergo surgery will require quitting for several weeks prior to your surgery.
Be free from physical conditions or diseases that are known to affect healing.
Have realistic expectations about surgery, recovery, and outcomes, and are fully prepared and informed about what to expect.

After Surgery

Preparing for Your Surgery

Your recovery will proceed better if you plan ahead with some preparatory steps:

Fill any prescriptions for pain medications or antibiotics in advance, rather than stop on the way home.
Arrange to have someone accompany you home and stay with you for the first 24 to 48 hours. If you have children, enlist help for at least the upcoming week to ten days.
Ensure you have reviewed and understood any post-operative instructions we provide, such as how to cleanse the incision or apply ointment, or care for and empty drains, if inserted. Get all your questions answered in advance. Your doctor will, of course, be available for any emergencies, but it is important that you understand all it entails before undergoing surgery.
Although you will not be completely laid up for an extended period of time, be sure to have healthy, easily prepared food and beverages readily available. It is easy to skip meals when you are not feeling your best or as a side effect of pain medications, but you need nutrition to help your body recover. It is also important to stay hydrated.
To reduce swelling and pain, you will have to sleep on your back, with your head and upper back elevated. This can be a challenge, particularly if you tend to sleep on your side or stomach. Be sure you have all the support pillows you need, and try out different configurations ahead of time, so you can make yourself comfortable as quickly as possible. You will need plenty of rest to heal; you will also want to minimize the stress you could put on sutures by tossing and turning.
Wash your hair. You won’t be able to raise your arms over your head for one week after some surgeries.
Have loose clothing available to minimize friction against the breasts.

Getting Home

Immediately after surgery, you will be taken to a recovery room, where you will be monitored. Most patients are considered stable for discharge within an hour or so. However, “stable for discharge” does not mean that you will be feeling fine and able just to pick yourself up and go home.

Many patients experience nausea from the anesthesia and may have blurry vision. Most feel weak and tired (they have just had major surgery, after all), and all will have pain or discomfort, swelling and bruising. You will have pain medication to keep you comfortable in the early stages of healing.

A General Timeline

Everyone heals differently and at a different rate, and recuperating can vary, based upon the type of incision, and the location and size of the implant. So be sure to follow aftercare instructions exactly.

For the first few days, it is normal to experience swelling, pain and discomfort, and bruising is common. Prescription pain medication can keep you comfortable. Take your antibiotics exactly as prescribed, for as long as prescribed. You cannot take pain reliever with aspirin or ibuprofen until given doctor’s permission, as these painkillers thin the blood, which could lead to excessive bleeding.
You may be asked to put cold compresses on your breast for the first 48 hours.
Any drains may be removed within a few days to a week; removal is painless.
Keep your incisions dry and only apply ointments or creams given to you by your doctor; others may cause inflammation.
Monitor your temperature regularly to ensure you don’t have an infection.
If your nipples are very erect or sensitive, you can protect them from friction with bandages or nursing pads.
To minimize the risk of blood clots, resume light activity, such as walking around the house, as soon as possible after returning home.
If you have a job with very little physical activit, you may be able to return to work within a week.

At Lyos Plastic Surgery and Dermatology Associates, we want our patients to be educated, informed, and confident. Dr. Lyos holds three board certifications and is an exceptionally talented and experienced plastic surgeon and recognized as a premier Houston plastic surgeon. Have questions? Connect with us to discus breast augmentation, and what surgical procedure will be most appropriate for you.