Patients have three options when it comes to the location of their incision (and therefore the scar) for breast augmentation surgery: the inframammary crease (under the breast), the periareolar (around the areola), and the transaxillary (armpit) incision. Each incision has its own advantages and disadvantages. It is important for patients to consider these factors since the choice of incision location can have both short-term and long-term implications. Luckily, we have scientific studies which provide good data to help patients make decisions to get the best result for today and in years to come.
INFRAMAMMARY CREASE INCISION
The Inframammary crease incision (in the breast crease under the breast) is the most common location for breast augmentation surgery in North America. There are several reasons why over time this incision has become number one for patients. Firstly, this incision can be used for any type of implant and any size of implant giving women greater choice for their implant as this incision does not put any limitations on the implant size or type. Secondly, the incision under the breast allows the surgeon to create the implant pocket either under the muscle (aka subpectoral or “dual plane” as it is often called) or on top of the muscle (aka subglandular) depending on the patient's existing tissue and desires. This incision results in a scar that is hidden under the breast, so that in the standing position the scar is not generally visible as compared to the incision around the areola (aka periareolar incision) which results in a scar directly on the front of the breast. This incision under the breast also results in less disturbance of the breast tissue itself as the surgeon is able to stay directly under the muscle and the breast gland rather than having to divide the gland from front to back to create the space known as the ‘pocket’ for the implant. This has significant benefits to the patient with regards to lowering the rate of capsular contracture which has been shown to be significantly higher when the periareolar or transaxillary incision is used.
There are studies that also suggest less breastfeeding difficulty with the incision under the crease. Finally, the incision under the crease allows for what some surgeons and patients refer to as “Rapid Recovery'', or “Flash Recovery” breast augmentation. These terms are borrowing ideas and methods put forth by Dr. John Tebbetts, a world-renowned plastic surgeon and leader in the field of breast augmentation. Dr. Tebbetts stressed the need for handling tissues gently, minimizing or eliminating bleeding, using appropriately sized implants based on the patient’s frame and existing tissues. Many surgeons including Dr. Beber have found that following these principles leads to improved patient experiences and aesthetic outcomes.
The periareolar incision is generally placed along the lower edge of the areola where it meets the normal skin. There are some benefits to this incision. When it heals well, it can blend in with the natural color change from the areola to the breast skin. It can be used in certain cases to make the size of the areolar smaller, or raise the areola position. Unfortunately, studies have shown that the most common complication of breast augmentation, called ‘capsular contracture’, is significantly higher when the incision is placed around the areola. Studies also suggest that this incision causes more potential problems with future breastfeeding. The scar is located directly on the front of the breast, and less hidden than underneath the breast depending on how a patient heals. In addition, the size of the areola diameter can limit the size of the implant that can be inserted. Finally, if the size of the areola is small, certain revision surgeries may not be possible through the same incision and may require a different incision (and therefore a scar) down the road. For these reasons, and the higher complication rates are shown in the scientific literature, many surgeons recommend against this incision choice.
The transaxillary incision in the armpit is the least common choice for patients according to the literature. It does however have the advantage that no scar is placed on the breast itself. However, the scar in the armpit can prove problematic as it is located in an area that is visible to the public when the arms are lifted – think bathing suits, gym attire, strapless dresses etc. Scientific studies also show the transaxillary incision to have higher rates of capsular contracture compared to the incision under the breast, as well as higher rates of implant malposition, and overall a higher rate of the need for secondary surgery due to adverse events.