Breast Augmentation: Cost, Reviews, Photos

Umbilical breast augmentation not Encourage or Recommended

Most board certified plastic surgeons will NOT perform this operation as they genuinely know better.

This is not a good procedure and is know to have issue with it.

Most commonly since it is a blind procedure like the arm pit incision (which has shown to have a high rate of malposition) it too has the same issues.

The periareolar incision heals exceptionally well, so why take the risk and chance with your breast surgery. Remember if it is not done right the first time, it will never be the same. (Farbod Esmailian, MD)

I do not perform this procedure but in courses I have attended the implant can be placed under the muscle if the surgeon has a lot of experience.

The problem with this procedure is that it is novel and many non-plastic surgeons will offer it to try create a niche. I personally do not like the procedure because it is essentially performed in a blind fashion and I have seen patients with marked asymmetry and implant malposition after umbilical breast augmentation.

You also must realize that if there were a need for re-exploration such as for bleeding or pocket repair, you will end with a scar on your breast anyway. I would recommend you meet with a board-certified plastic surgeon to review your options. (Michael C. Edwards, MD, FACS, Las Vegas Plastic Surgeon)

You have to understand that the Umbilical breast augmentation submuscular approach, from what I understand, is essentially a blind procedure.

That means that you have to guess that you are under the muscle when placing the conbduit from the umbilicus. This is not a precise operation and therefroe the vast majority of plastic surgeons are somewhat reluctant to perform it. (Otto Joseph Placik, MD, Chicago Plastic Surgeon)

I recently saw a patient who had the Umbilical breast augmentation operation performed in California. She presented with quite a marked asymmetry. At surgery we discovered that they had placed one implant on top of the muscle and the other under the muscle. I have never seen or heard of this done by the more the standard procedures. It is very difficult to get good symmetry with this operation. (Robert M. Jensen, MD, Medford Plastic Surgeon)

I don’t know any experienced board certified plastic surgeon in Manhattan who does the umbilical breast augmentation procedure. If you have implants put in through the belly button, the warranty becomes void. That tells you what the manufacturer thinks of this operation. (George J. Beraka, MD (retired), Manhattan Plastic Surgeon)

TUBA or TransUmbilical Breast Augmentation is probably the rarest method of breast augmentation. It sounds appealing since the incision is in the umbilicus or belly button. However, procedures through this incision for the breast are very difficult to obtain comparable results to the more common methods of breast augmentation.

The implant can be placed under the muscle through this method, however, alignment and placement are more difficult to obtain through this method. (David Shafer, MD, New York Plastic Surgeon)

There is a reason why transumbilical breast augmentation has not gained wide acceptance in the plastic surgery community. The concept is great. The practice is limited by the technical difficulty of controlling the results from such a remote access and to the use of saline implants. (Kenneth R. Francis, MD, FACS, Manhattan Plastic Surgeon)

Incision placement for breast augmentation

Several incision locations are commonly used: the axilla, around the nipple, or in the crease below the breast.

Transumbilical or transabdominoplasty approaches are sometimes used, but have significant potential downsides in terms of implant malposition, crease disruption, etc.

The axillary breast augmentation incision is difficult to hide in clothing such as a tank top or bra. It also provides suboptimal exposure to adjust the implant position such as altering the breast fold higher or lower.

Small areolae limit the size of the periareolar incision that can be used.

For these reasons, I usually prefer the inframammary crease incision below the breast, which can be hidden in almost any garment. (Erik Hoy, MD, Newark Plastic Surgeon)

Inframammary or umbilical breast augmentation incision

One of the most common incision placements is underneath the breast, in the inframammary fold. This scar would be well hidden by your bra or bikini top. You can also consider the transumbilical incision, where the incision is hidden by your belly button. This would probably be the least apparent scarring. Inframammary incision is an option (Michael Constantin Gartner, DO, Paramus Plastic Surgeon)

Transaxillary breast augmentation incision Is The Way To Go!

Transaxillary (armpit) endoscopic (surgical camera) breast augmentation can be performed for either saline or silicone implants. Although the scar needs to be larger to place a silicone instead of a saline implant in the pocket, it can be done. If your nipple areolar complex diameter is very small, it is impossible to place a silicone implant via the periareolar (nipple) breast augmentation incision.

If this armpit approach is performed using a surgical camera, it is the most modern, sophisticated way to create the space, shaping the breast under direct vision. There is very little bleeding and bruising because all of the blood vessels are visualized and the bleeding is stopped before it even starts. The pocket shape is very precisely created, resulting in fewer revision surgeries for implant malposition.

The incision is hidden in an existing crease in the armpit, and behind the muscle. The scars are very well hidden, as opposed to the inframammary fold (chest wall) incision, which can either ride up on the breast, or be place too low and show on the chest wall below the bikini. It is a very specialized approach which requires extra equipment and extra experience from the surgeon. Make sure that the board certified plastic surgeon has enough experience with transaxillary endoscopic breast augmentation. (Gary Lawton, MD, FACS, San Antonio Plastic Surgeon)

Incision type for augmentation

While answers may vary, I personally would recommend placement through an infra mammary incision. This will optimize chances for precise placement of the implant and minimize any risk of damage or contamination to the implant during placement. Because the implant will provide the majority of the breast shape for you, it’s placement will be especially critical in achieving a nice outcome. (Earl E. Ferguson III, MD, San Antonio Plastic Surgeon)

Breast augmentation incision type

The placement of the incision is a decision shared with the patient and physician. The silicone implants are ideally placed through the crease incision. This allows perfect placement beneath the muscle and permits the plastic surgeon to use a larger implant. (Frank J. Ferraro, MD, Paramus Plastic Surgeon)

Breast augmentation armpit incision

In my practice, we primarily use and endoscopic approach with an axillary (armpit incision). Most of our patients have small areolas and nipples, just like yours. Hawaii is predominantly an Asian population and this could be why.If the incision is made at the top of the armpit, in a preexisting wrinkle or fold, the scar can be invisible.

I prefer the armpit incision because the periareolar incision or the perithelial incision (next to the nipple, within the areola) usually leads to loss of sensation in the nipple.My patients end up with minimal scars. As long as the incision in the armpit is properly placed, your scarring should be minimal.

I would suggest you seek a plastic surgeon that employs an endoscopic technique, otherwise the procedure is performed blind with blunt dissection, which in my opinion leads to more risk of complications. (Shim Ching, MD, Honolulu Plastic Surgeon)

Axillary Breast Augmentation incision

Transaxillary breast augmentation is becoming an increasing popular method as technology continues to improve. There are several misconceptions about axillary breast augmentation. First of all both saline and silicone implants can be used with this method. Many patients and surgeons that do not commonly perform this surgery don’t know that a silicone implant can be placed from an axillary incision. Secondly the incisions in the axilla is just as small as it would be if it was placed around the nipple or under the breast.

The breast augmentation incision is well concealed in one of the natural arm creases in the axilla. Thirdly the use of the endoscope has made the procedure very precise as the entire breast pocket is created under direct vision. This method has become very popular in Miami as it avoids putting any incisions on the breast , thus decreasing the chances of altering nipple sensation. (Johnny Franco, MD, Miami Plastic Surgeon)

Armpit incision for breast augmentation

More and more, plastic surgeons are moving away from nipple incisions for due to an increased chance of getting capsular contracture (hardening of the implants).

Now, whether to go inframammary (breast crease) or transaxillary (armpit) is up to the patient and the surgeon. The inframammary incision is widely used and allows the implant to be placed either above or below the muscle.

For a Silicone implant of that size, a 4-5 cm incision will need to be made depending on it the implant is textured or smooth.

Incisions in the armpit generally heal very well and are barely perceptible as they are placed in the natural skin creases.

The implants can only be placed under the muscle using this technique. Some surgeons elect to use an endoscope (camera assisted) in order to visualize the entire procedure, eliminating any “blind” dissection.

The advantage to this technique is that it does not place any scars on the breast. Keep in mind that any revision work in the future will likely require the breast crease incision. Both are excellent and well accepted approaches to breast augmentation and It is important to talk to your surgeon about their experience and your goals. (Kunaal Jindal, MD, Toronto Plastic Surgeon)

What is the best incision for breast implant placement?

There are 4 options for incisions for breast implant placement Infra mammary crease incision. This is my preferred incision. The scar is hidden underneath the breast and mostly can’t be seen unless you are naked and lying down. It also allows you to best control the position of the implant. Armpit incision.

This is the only incision which is visible when you are clothed and doesn’t give you good control over the position of the implant Areolar incision (around the nipple). This gives a great scar which is hard to see. There is a slightly increased risk of infection of the implant with this incision however Umbilical (through the belly button).

I’ve never seen or used this technique, and it can only be applied in cases of saline implants (which I never use). It involves an incision near the belly button, tunnelling an empty implant into the chest area and then filling it with saline.

Difficult to control the position of the implant with this one. So if you are worried about your scar being visible at the beach, I would avoid an armpit scar. (Damian Marucci, MBBS, FRACS, Australia Plastic Surgeon)

Pros and cons of axillary incision

No incision for Breast implant placement is perfect. See link below for a fuller explanation. Here’s a quick recap: Inframammary – Pro Most common incision, well hidden if all goes well. Con-If the implant settles even a little bit, the scar is right there to be seen in the lower pole of the breast. Areolar – Pro- Always a good scar, allows for best placement options Con-Technically more difficult.

Axillary – Pro- Best hidden scar Con- Only suitable for breasts with no ptosis and a broad base. Needs very precise placement. Iwould be very comfortable using an axillary incision in your case. Pick a surgeon who can show you examples of breasts that look like yours done with an axillary (Ricardo L. Rodriguez, MD, Baltimore Plastic Surgeon)

Silicone gel implants and small areola

I just performed a breast augmentation on a patient with one very small areola (diameter less that 3 cm). The size of her areola appeared similar to yours. I placed 350cc silicone gel implants using a Keller Funnel. An inframammary or transaxillary(through the armpit) approach would have made insertion easier, but I prefer the periareolar approach for dissection of the pocket. The decision depends on patient preference for scar location, and surgeon preference of approach. Be sure to discuss all these options thoroughly with your surgeon. The transaxillary “armpit” incision allows scarless breast augmentation – the best way to go for women that do not need a lift. (Brian D. Kent, MD, Tulsa Plastic Surgeon)

You can use it to place the implants beneath the muscle, but why would you! Umbilical breast augmentation is one of 4 main access incisions used for breast augmentation but is by far the most infrequently performed.

If you are absolutely decided on umbilical breast augmentation then please seek out a plastic surgeon that performs a high volume of that particular procedure because

There is a VERY steep learning curve. If you go to a surgeon that only performs 30-40 a year you will still be one of the patients he/she is learning on.

By no means do I want to try to persuade you if you are absolutely convinced that TUBA is what you want, but you have to understand that you have to have saline implants – silicone is NOT an option.

You also tend to have a longer recovery because you have a much larger area of tissue trauma (all the way from your belly button to your collar bones).

Most if not all of the procedure is performed with a tissue expander which separates the tissue bluntly and can lead to significant bleeding and tissue trauma. You also have a higher chance of malpositioning (asymmetry). (Richard H. Fryer, MD, Salt Lake City Plastic Surgeon)

Umbilical breast augmentation is not a widely performed procedure. Most board certified plastic surgeons would choose other methods.

The umbilical breast augmentation cannot be done with gel implants and the manufacturers do not like to have the implants placed this way do to the ruff handling of the implant during the procedure. (John C. Pedersen, MD, Akron Plastic Surgeon)

Of all the remote access incisions for breast augmentation, I am most reluctant to endorse this one for the following reasons:

1. It doesn’t allow refinements of the dual plane pocket dissection, so that the cleavage is a function of how much the pectoralis muscle can be avulsed (stripped) off the breast bone. Additionally, if the breasts are intially uneven, with regard to the distance from the nipple to the fold, very little adjustments can be made to correct these fold differences.
2. It involves folding the empty saline implant and introducting it through a metal tube, with all the risks of shearing and damaging the implant, thereby possibly facilitating a late deflation.
3. The track made by the introducer will leave an oblique ridge in the midriff area, which is quite objectionable to the patients. It will resolve with some massage and time.
4. It’s a one time approach. In the event, that you develop a capsular contracture or deflation, improvement of the breasts, cannot be done through this remote approach. Your consultant will inevitably recommend a more direct approach: periareolar or inframammary fold, which is more direct and provides a more consistent outcome. I’m confident you’ll make a good decision. (Lavinia K. Chong, MD, Orange County)

Breast Augmentation through umbilical not recommended

Umbilical breast augmentation is not recommended by breast implant manufacturers and by most plastic surgeons. It is truly a blind approach and can commonly lead to malpositioning. I give my patients this analogy whenever they ask about umbilical breast augmentation.

Imagine putting lipstick on your lips, not with the normal short stick, but attached to the end of a broom handle! Why would you?? It’s a lot easier and safer to do it with a periareolar (around the nipple) or infrmammary (under the breast) approach. There are very few people in the country that can do this operation with success. That should give you an idea why most plastic surgeons do not do this procedure. (Sirish Maddali, MD, Portland Plastic Surgeon)