Breast Enlargement Surgical Techniques: Incision Location

Breast implants for augmentation may be placed via various types of incisions:

• Inframammary - an incision is placed below the breast in the infra-mammary fold (IMF). This incision is the most common approach and affords maximum access for precise dissection and placement of an implant. It is often the preferred technique for silicone gel implants due to the longer incisions required. This method can leave slightly more visible scars in smaller breasts which don't drape over the IMF. In addition, the scar may heal thicker.
• Periareolar - an incision is placed along the areolar border. This incision provides an optimal approach when adjustments to the IMF position or mastopexy (breast lift) procedures are planned. The incision is generally placed around the inferior half, or the medial half of the areola's circumference. Silicone gel implants can be difficult to place via this incision due to the length of incision required (~ 5 cm) for access. As the scars from this method occur on the edge of the areola, they are often less visible than scars from inframammary incisions in women with lighter areolar pigment. There is a higher incidence of capsular contracture with this technique.
• Transaxillary - an incision is placed in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast and is more likely to consistently achieve symmetry of the inferior implant position. Revisions of transaxillary-placed implants may require inframammary or periareolar incisions (but not always). Transaxillary procedures can be performed with or without an endoscope.
• Transumbilical (TUBA) - a less common technique where an incision is placed in the navel and dissection tunnels superiorly. This approach enables implants to be placed with no visible scars on the breast, but makes appropriate dissection and implant placement more difficult. In that regard, it is pertinent that a published medical journal report analyzed a consecutive series of more than 1300 TUBA cases done by a single surgeon over a 15 year span, with no instance of incorrect implant placement. Transumbilical procedures are performed bluntly, with or without an endoscope (tiny lighted video camera) to assist dissection. This technique is not appropriate for placing silicone gel implants due to potential damage of the implant shell if attempting insertion through the small 2 cm incision in the navel, and as those implants are pre-filled they cannot be passed through that incision.
• Transabdominoplasty (TABA) - procedure similar to TUBA, where the implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty procedure.
• Areolar Vertical Approach (AVA)- the technique created by Dr. Lejour and developped by Dr. Van Thienen, is a very similar approach to the periareolar as the insicion is the same, but leaves a more extended submuscular pocket for the Silicon Gel Implants, through the transglandular sectione to the top pectoral fascia. The cavity is drained after being washed with Saline solution before the implants are placed. This technique developped in Argentina was proved to have excelent results even after numerous long term surgeries.
  

Breast Enlargement Surgical Techniques: Implant Placement

Breast implants placed under the pectoral muscle can provide a more natural look but require more extensive surgery and a more painful recovery. Subglandular placement of breast implants for breast enlargement is easily accomplished and allows quicker recovery, but the results may not be as natural-looking. Learn more about submuscular placement and subglandular placement of breast implants and the pros and cons of each method.