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What is Breast Augmentation?

Breast augmentation is a surgical procedure in which a breast implant is used to enlarge the female breast. This is one of the most popular cosmetic surgical procedures in the world. Although the surgery is relatively straightforward, there are many options to consider, including implant type, size, and shape, incision location, and implant placement (above or beneath the pectoral muscle).

Incision Placement

There are 4 different incisions which can be used to insert a breast implant. The inframammary incision places the scar in the fold underneath the breast. The periareolar approach places the incision at the border of the areola and the surrounding breast skin. The transaxillary incision is placed in the armpit. The transumbilical (TUBA) procedure uses an incision in the belly button for implant placement. All of these procedures can be used to successfully perform a breast augmentation, but each comes with its own set of advantages and drawbacks.

The inframammary approach is among the most popular incisions in use today. It hides the incision underneath the breast so the cosmetic result tends to be very good. Accessing the breast from the fold is technically straightforward and minimally traumatic to the breast. In addition, the risk of capsular contracture, nerve injury, and breast feeding compromise are all lowest with this approach.

With the periareolar incision, an incision is made on the lower part of the areola. The main advantage of this approach is that the scar may, in some cases, heal to the point that it is functionally invisible. Capsular contracture rates can be significantly higher, however, and there is more damage to the breast gland than is seen with the inframammary approach, so nerves and milk ducts may be compromised.

Transaxillary incisions can be used for both saline and silicone implants. A small incision is made in the armpit and then the surgeon tunnels into the breast, often with the aid of a small camera. The main advantage is that it keeps the scar off the breast entirely, but capsular contracture rates and precision both suffer.

Transumbilical placement of implants can only be done with a saline implant. With this method, the surgeon tunnels through the belly button and all the way up to the breast, places the implant and then fills it. The tunneling can leave potentially permanent contour irregularities along the abdomen, and like the transaxillary approach, this is a remote access placement of the implant, so accuracy and symmetry are compromised. Finally, the approach voids the warranty of the implants due to the use of instrumentation to handle the device.

Because of the limitations of the axillary and umbilical approaches, Drs. Vath, Wolfe and Steinwald use only the inframammary and periareolar incisions.

Above or beneath the muscle?

Implants can also be placed in two different positions or planes, above or beneath the pectoralis muscles on the chest wall. Subglandular placement is when the implant is above the muscle, subpectoral is when it is beneath. Again, there are advantages and drawbacks to both. Subglandular placement is less painful, and there is no distortion of the implant when the muscle is flexed. Implants placed above the muscle may be more visible and palpable, however, and have a higher rate of capsular contracture. In addition, mammograms are more significantly compromised by subglandular implant placement.

Subpectoral implants are better camouflaged, so they feel and look more natural. The rate of capsular contracture is significantly reduced, and mammograms are more effective. The process of placing implants under the muscle is more traumatic, though, so a slightly longer recovery is may be required. The implants may be distorted by muscle flexion in some cases.

These are only some of the considerations that must be taken into account when deciding whether to have a breast augmentation, and how have it performed if you move forward. Augmentation is a complex procedure, and long term patient satisfaction requires an experienced surgeon with an advanced understanding of all aspects of the surgery. As experts nationally recognized in the field, Dr. Wolfe, Dr. Vath, and Dr. Steinwald perform hundreds of breast augmentations every year, and are comfortable with even the most challenging cases. They can explain the procedure to you so that you can understand your options and make a fully informed decision and get the result you desire.