Breast augmentation surgery is a big decision and when you finally make up your mind and go for it, there will be a bunch of important questions and choices to make. The choice of type and material of an implant, implant placement, and the incision site. In this article Korean breast plastic surgery specialist, Dr. Seul Chul Hwan will tell you about the characteristics, downsides, and upsides of each incision method used for breast augmentation surgery. Dr. Seul will tell you what incision is the most beneficial for recovery and brings the least risk of side effects.
There are four main incision methods used for breast augmentation surgery: 1) Submammary incision, 2) Periareolar incision, 3) Transaxillary incision, and 4) Belly button incision
Each incision method has its advantages and disadvantages. Furthermore, they might be more or less suitable depending on the particular case. I will start with the most controversial incision method and finish with the one I recommend the most to the majority of my patients.
1. Belly button incision
This incision method is almost out of use. Despite having the advantage of minimal scar visibility – the scar is hidden below the edge of the belly button; it has a tremendous number of serious disadvantages. First of all, it is suitable only for saline implants, which are inserted empty in the pocket and then filled with saline using a pipe, that goes under the skin to the inserted implant shell. Moreover, while the outside incision site might look small, the incision under the skin is the biggest, so the bleeding is greater than in other methods. Dissection under the skin, also cannot be as precise and it is difficult to perform the revision surgery. The healing process is also more painful and time-consuming. This method is outdated, prone to side effects and I don’t recommend it.
2. Periareaolar incision
Periareolar incision is made around the edge of the areolas. This incision method is still popular, and it is suitable for special cases, for example when there is a major contraction. It has also the least visible scar and the recovery is relatively quick. It also makes the surgery more precise as the visibility range in this method is really good. Despite having these advantages, it has the biggest disadvantage due to the increased possibility of infection or capsular contracture. The implant will be inserted in the close vicinity of lactiferous ducts. There are bacteria living in lactiferous ducts and if they got inside the implant pocket, they may cause the infection or/and capsular contracture.
3. Transaxillary incision
A transaxillary incision is made under the armpit, in the place where there are natural wrinkles, to effectively hide the scar. This method of incision is universally used and is often chosen by patients because the scar can be hidden under the armpit. It also doesn’t have the increased probability of infection, as in the case of a periareolar incision. However, the disadvantage is the relatively big incision site and limited precision, which results in more bleeding. Especially if the blunt metal dissection device is used instead of the cleaner and more precise endoscope. While I always use the endoscopic method, there are still clinics that use blunt metal dissection – it is a quicker and easier method.
Transaxillary incision is more precise, and the recovery is faster and less painful when the HD endoscope is used. However, even in the case of well performed endoscopic method, the recovery process will be longer and more painful than if the submammary incision method were used. Revision surgery is also more difficult for this method and it usually requires performing an additional incision under the breasts. Unless the revision is also performed via an endoscope, which on the other hand requires exceptional skill and cannot be successfully performed by surgeons who aren’t used to the device.
4. Submammary incision
The submammary incision is made right under the breast. While it seems that the scar is the most visible in this method it is actually hidden in the submammary fold, so if it is performed well, with minimal incision, just to fit the endoscope, you shouldn’t be worried about the scar visibility.
This method has multiple advantages. First of all, it is the safest and the least prone to complications. The visibility range during the surgery is the greatest, so it allows the surgeon for the most excellent precision. The actual incision site is relatively small and precise; therefore, the bleeding is minimal, and the recovery process is fast and least painful. It is also a good choice for people with an active lifestyle because it usually allows for light sport activity earlier than one month after the surgery and for the more demanding exercises (running, heavy weights) around three months after the surgery. It is also beneficial in cases of sagging or contracted breasts.
The submammary incision method had a lot of advantages, but there are cases when I would rather recommend getting a transaxillary incision instead. It is when the submammary crease is not fully formed yet and cannot help with hiding the possible scar.
Conclusion
If I were to choose which incision site is the most beneficial, I would say that it depends on the case. For most instances, the submammary incision seems to be the best solution. However, it is important to assess each case individually, considering the characteristics of the patient’s body, scarring, lifestyle, and desired effect. As a plastic surgeon with more than 22 years of experience with thousands of patients, I would say that the individual approach is the most important factor for the successful surgery and satisfactory effect.
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