All About Breast Augmentation

There are typically 4 well described incisions for placing breast implants. I’ve performed breast augmentations using all 4 approaches. Each has its own advantage and disadvantage as I’ll explain. Plastic surgeons are often partial to one or two approaches. I’ll explain my reasoning why I prefer either the breast fold (or IMF) approach or periareolar (around the nipple approach).

The transumbilical or TUBA (thru the belly button) approach saves a scar, but the incision and instrumentation is remote from the breast. Much of the operation is done blindly, and the pocket dissection for the implant can often be imprecise. Implants tend to migrate down the road and so there is likely a higher revision rate. Also, silicone implants can’t be placed this way. For these reasons, I think a belly button approach is not worth the added risk of higher breast asymmetry or implant malposition.

The same reasoning applies to the transaxillary approach or ‘armpit’ incision. This too, is a remote location from the breast. Pocket dissection is thus less precise, and the implants have a tendency to fall out giving wide spaced cleavage. It is also very difficult to place large silicone implants through the armpit.

Surgeons that advocate these two approaches primarily do so because the scars are ‘hidden’ and the operation can often be done much more quickly. I do not believe these reasons should take precedence over breast shape and symmetry.

Both breast fold and periareolar incisions leave either well hidden or camouflaged scars. The incisions provide direct access to the implant pocket. Both saline and silicone implants can usually be placed through these incisions. Results from this approach are often better down the road and often require less re-operations. EVERY PATIENT IS DIFFERENT & THE APPROACH SHOULD BE CUSTOMIZED TO THEIR DESIRES AND ANATOMY. For example:

For a natural look in a woman with large enough areoala, silicone implants through the areaola can look wonderful:

Below are you see a breast augmentation of a 375 cc silicone, periareolar approach, submuscular position procedure:

This woman had smaller saline implants. She desired a fuller chest. Incisions placed in her crease hide the incision very well.

Removal & replacement (250 cc saline to 450 cc high profile silicone) Subglandular, inframammary approach

Sometimes, a subglandular approach can correct what is called pseudoptosis (where the breast tissue lies lower than the nipple). Here, silicone implants were placed in the well hidden breast fold OVER the muscle to ‘raise’ the nipple.

Below, a subglanduar approach placed properly can obviate the need for a lift and extra scars.

450 cc moderate profile silicone, subglandular, periareolar

In summary, every patient’s desires and anatomy are unique and should be carefully considered when investigated breast augmentation. For more information on silicone and saline and the different approaches, please refer to my articles in LA2Day.