Breast Augmentation Incision Scars
Breast augmentation incision scars for silicone implant
My preferred method is actually to place the silicone implant under the muscle through the infra-mammary fold.
When you go through the nipple you are cutting through normal breast tissue which raises infection rates, possible breast feeding issues, etc.
The armpit incision can damage the integrity of the silicone gel with such a large implant.
The infra-mammary fold incision I feel is the least noticeable, safest way to create a pocket for a silicone implant. (Michael A. Fiorillo, MD, New York Plastic Surgeon)
Incision Choice for Breast Augmentation
It is a common misconception that the armpit scar is invisible. It is frequently seen when one raises their arms overhead. It also is in close proximity to many nerves to the breast and inner arm, which can cause increased dysesthesias and hypersensitivity. I prefer the inframammary and peri-areolar scars in my practice.
I use very small incisions for a 350 cc implant and based on your photo I think you are a candidate for either one. I do find that the peri-areolar scar does carry a slightly higher chance of sensation change compared to traditional inframammary scar and therefore tell my patients the safest approach is always inframammary incision.
Therefore, I would recommend a small inframmamary incision with submuscular placement of your 350 cc silicone gel implant. This incision can be nicely camouflaged in the breast crease and be much less noticeable than an armpit incision. (Paul S. Gill, MD, Houston Plastic Surgeon)
Scar Incisions for Breast Augmentation
For your nipple size best not to go through the nipple. As far as the incisions on the arm pit vs below the breast either scar can be minimal since you are fair skinned. Most people will be impressed with the breast size and not really see the scars. Make sure your surgeon is experienced in either approach. (N. Bill Aydin, MD, Paramus Plastic Surgeon)
Breast Augmentation Armpit Approach
Breast augmentation through the arm pit is usually done blindly and bluntly. Normally, the surgeon does not see the inside of the pocket, and the pocket is created by tearing the tissues from their connections.
Some doctors, however, use an endoscope to view the inside of the pocket. In this situation, the tissues can be cut while viewing them through the scope. When the procedure is done blindly and bluntly, there is less opportunity to precisely create the pocket. Accurate pocket creation is the most important component of a good breast augmentation. When the operation is done blindly, there is more blood remaining in the pocket, which can lead to a hard breast later on.
If the areola is big enough, the implant can be inserted through an incision along the edge of it. The incision will need to be at least four to five centimeters in length to be able to softly pass a silicone implant through it. A saline implant can be passed through a smaller incision because the implant is usually put in empty and the fluid is then added.
It is very important to consult with a plastic surgeon that is well trained and experienced in all types of breast surgery. He or she can listed to all of your concerns and help design the best option for you. (John J. Edney, MD, Omaha Plastic Surgeon)
Armpit scar incision for silicone implants
The armpit incision is not as popular anymore because of the increased chance of infection and other complications. Your areolas are too small so you are looking at an IMF incision. These generally heal up well so I would not worry about the scar. Unfortunately, any type of breast augment is going to leave a scar. The other problem with the armpit incision is if it heals poorly, then it is hard to hide. (Kurtis Martin, MD, Cincinnati Plastic Surgeon)
Breast incision Options for Silicone Implants and Small Nipple-Areolae
Placing silicone implants through the armpit breast incision is a very reasonable option for your situation.
If you prefer, the implants can also be placed through the nipple-areola breast incision even though yours are not very large.
The implants can be placed through a very small nipple-areola breast incision with or without the assistance of a device known as the Keller Funnel.
I use the Keller-Funnel (which is a sterile device similar to a baker’s icing bag) to place large silicone implants (usually 500+cc) through a fairly small breast incision.
If your surgeon does not use the Keller Funnel, then the armpit breast incision is a very reasonable alternative. (Louis DeLuca, MD, Palm Beach Plastic Surgeon)
Breast incision placement for breast augmentation
It is possible to place a 350 cc silicone implant through a peri-areolar breast incision that is about 3.5 cm in length. I would guess that despite having small areola, you could still use the peri-areolar approach because the lower arc of your areola is still 3.5 cm long. This approach is nice for hiding a scar in most patients.
The axillary approach is also a possibility for you, but you would need to find a board certified surgeon comfortable placing gel implants through the axillae. I personally do not do so, but others do. Here is what I tell my patients: The scar with any approach is usually not much of an issue (if the surgery is done properly).
Most patients heal a well controlled, small incision extremely well. If you have a nice scar, it doesn’t matter if it is in the armpit, along the areola, or under the breast in the fold. In the off chance that you make a dark, raised, or otherwise unfavorable scar, it might matter where the scar is.
If it is along the areola, you will see it all the time. If it is in the armpit, you will be self-conscious about it anytime you are not wearing sleeves. If it is in the breast crease, it will be hidden all the time unless your arms are in the air or you are lying down. In my personal opinion, the breast crease breast incision is the best choice in almost all of my patients. There is better control of the development of the implant pocket, better control of bleeding during the procedure, and the scar is hidden 99% of the time. Although I do not have any published data, I have clinical evidence that the capsular contracture rate is lower using the inframammary approach when compared to the other incision choices.
I also believe that precise implant positioning is easier and more predictable using the breast crease approach. The breast crease incision can be placed in such a way that the chances of it ending up on the breast itself is extraordinarily low and once it has faded with time, it is almost un-noticeable. I would at least consider this approach for your surgery. (William T. Stoeckel, MD, Raleigh-Durham Plastic Surgeon)
Best breast incision for Silicone Implants
When considering Silicone implants the inframammary fold breast incision should be the usual approach. This location is hidden well after healing and its size prevents micro- fracturing and weakening of the silicone shell which holds the implant material. However, if the patient has a large Nipple-Areolar complex then one can insert a Silicone implant through a periareolar breast incision without causing damage to the implant shell. (Paul Vitenas, Jr., MD, Houston Plastic Surgeon)
Armpit breast incision Has Advantages and Disadvantages Versus Other Approaches
The armpit breast incision has a great advantage of not having any incision at all on your breasts. If you take great post-op care of your breasts after surgery, you should end up with a great result. The problem of having a small nipple is an issue with silicone breast implants, but use of a Keller Funnel should make a nipple, or areolar, breast incision possible to place 350 cc silicone breast implants. The disadvantage of the armpit breast incision is that it may take some time for the swelling at the top of your breasts, going towards the armpit breast incision, to settle down. This tunnel underneath the muscle is created to place your breast implant. It will close down, but it may take several months. (Roy Kim, MD, San Francisco Plastic Surgeon)
Breast implant incision sites
There are basically four incision sites for putting in breast implants. They each have their own pros and cons. Your doctor can explain each of them in greater detail, however, here is a brief summary:
1. Crease incision for breast augmentation: This was the very first incision for breast augmentation used for putting in breast implants. The advantage is that it is right at the lower border of the chest muscle so it is the easiest incision from the surgeon’s standpoint for putting in implants either above or below the chest muscle. The downside is that the bra may rub on the incision site and, if you wear a two-piece bathing suit and raise your arms, the top might ride up enough that the scar could be seen.
2. Areola incision for breast augmentation: The color and texture change between the areola and the skin helps camouflage this scar. As you noted, one of the drawbacks is that, if you have a small areola, it may be difficult to make a large enough incision for breast augmentation to insert a silicone gel implant through this site.
3. Armpit incision for breast augmentation: The idea here is that the incision is located away from the breast itself and hidden in the armpit. The downside is that, if you have a noticeable scar here, it can be seen even when wearing sleeveless tops. Also, if you get any thickening of the scar, it may be difficult to shave the armpits over the scar. The angle of insertion is different from other approaches and may increase the risk of asymmetry as well.
4. Belly button incision for breast augmentation (TUBA): I have done more of these than anyone in the world so I like this approach, however, it can only be used with saline implants. Implants can be placed above or below the chest muscle with this approach.
Because it is the most distant incision site, again, there is a greater risk of asymmetry, especially if the doctor has little experience with this approach. On the plus side, there is only one incision and it is hidden in the fold over the belly button.
Also, there is little cutting of tissue so the recovery is easier than with other approaches. Armpit incision vs Periareolar incision for silicone breast implant (Edwin C. Pound, III, MD, Atlanta Plastic Surgeon)
Armpit incision vs Periareolar incision for silicone breast implant
I have used all incisional approaches to breast augmentation and in someone with your breast size I would probably be able to create a larger incision in your axilla than your areola – and that would allow easier/more predictable insertion of implants. Personally I would probably recommend an inframammary fold incision rather than a periareolar incision for breast augmentation.
There is no trauma to the breast tissue and ducts. There is less potential for infection and capsular contraction as well, in my opinion. The transaxillary approach also has a higher infection rate than the fold incision for breast augmentation. To be sure each approcah has pros and cons. Do your research, look at photos and talk to more than one surgeon. (Jon F. Harrell, DO, Miami Plastic Surgeon)