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Incisions, Age and Other Considerations Regarding Breast Augmentation

As one of the most popular cosmetic procedures performed in the United States, breast augmentation surgery has ascended to the level of an art. Since it was first performed in 1962, a variety of approaches and techniques have emerged. Today women in search of fuller breasts, more symmetrical figures, and a way to enhance their bodies' contours, have a number of choices.

While most women are well informed about these choices, the area of least sophistication tends to be incision placement.

Incision Placement
We can now introduce implants through four different types of incisions:

• Inframammary: (Incision under the breast )
• Periareolar: (Incision around the areola)
• Transaxillary: (Incision in the arm pit)
• Transumbilical: (Incision through the navel or TUBA)

In general, incision placement is based on the patient's individual preference. However, I am always willing to help you evaluate your goals to determine the incision that would work best for you. There are pros and cons to each incision site.

• With the inframammary incision, an approximately 1.5 inch incision is made in the fold under the breast. This is a popular choice because it becomes invisible when the patient stands upright.
• An incision around the areola tends to heal very nicely and becomes barely visible with time. This is placed at the junction of the darker and lighter skin color and at the bottom of the areola. I also quite frequently remove an ellipse of skin above the areola for a "crescent" type uplift and then place the implant through this cut. I use this approach frequently on patients who have had children or on my post-bariatric patients whose breasts have sagged and don't want the scars associated with a full uplift. This works quite well with a shaped implant in the latter patients.
• In regard to transaxillary incision placement, although there is no incision on the breast, it does leave small but visible scars that can be seen when you raise your arms. Also, this and the transumbilical approaches are essentially done blindly which may cause mispositioning of the nbreast implants. Furthermore, if another surgery is needed, like for capsular contracture, I would not be able to do it through either the armpit or belly button incisions.
• The transumbilical has gained some popularity. However, now that silicone implants are available for implantation, saline implants will most likely be used much less often and, therefore, so will this TUBA approach. There is no question that silicone implants provide a more natural result.

Questions I often hear in consultation:

Q: What is the recommended age for having breast augmentation?
A: Breast augmentation can be performed from an age of 17 years old on up. You are NEVER too old to improve the appearance of your breasts.

Q: Should I wait until after having children before having breast augmentation surgery?
A: Not necessarily. More than half the patients who get this procedure do it before having children. The majority of them have no problems breast feeding afterwards. Today we're well aware of how to minimize disruption of the glands to the nipple/areola. The underlying breast implant does not harm the breast-fed baby in any way but if you plan on getting pregnant within the year, I would wait until after you have had your children.

Q: How do I determine what size is appropriate for my goals?
A: This is a very personal decision. I see many women who just want to achieve a "natural look," to improve the proportionality of the upper and lower body and others who want to be much larger. It's really all about your goals. I take my time listening closely to your personal goals when determining what size implant I will use.

Q: Do breast implants interfere with mammography?
A: Yes. Breast implants, regardless of their location in the sub-muscular or sub-glandular location, can interfere with mammography but they do still visualize between 85-95% of the breast tissue. Mammography centers are well accustomed to performing mammography on patients who have had breast implants by taking a third view of the breasts.

Q: Can sensation of the nipple/areola be lost after breast augmentation surgery?
A: A small percentage (less than 2%) of patients have permanent nipple/areola sensation loss after breast augmentation surgery. Many patients have temporary loss or hyper-sensitivity of the nipple/areola complex.

Q: How do I know if I need a breast lift?
A: In general, evaluating the position of the nipple/areola complex in relation to the fold under the breast (infra-mammary fold) will help determine the need for a breast lift. I can do this during your consultation.

Q: What is the difference between High Profile and Moderate profile Implants?
A: High profile implants project farther than moderate profile implants and are narrower in circumference. Moderate profile implants are wider in shape and do not project as far. After listening to you and discussing your goals, we'll decide together the style of implant appropriate for you.

Q: Do I need to get my implants replaced every 10 years?
A: It is a very common misconception that you should have your implants removed and replaced every so often. The only reason you would need to have a corrective surgery is if the implant were leaking. Some women have their implants in for 25 years before they experience the need to have them replaced. Some women end up having them replaced at 7 or 8 years. If you don't have a problem, then you don't need them replaced!

Q: What is the most common complication you have experienced in doing this procedure?
A: The most common complication associated with breast augmentation is capsular contracture. This happens when the scar tissue that forms around the implant causes the breasts to harden (similar to what a contracted muscle feels like). This was much more common with the older, non-cohesive silicone implants that were used many years ago. This is much less common today, probably less than 15%. Even if it does occur, surgery is not needed. However, patients who elect to have revisional surgery find that it softens the firmness.

Q: How long is the recovery?
A: In general, if you work a Monday through Friday job that doesn't require excessive lifting, you can expect you will be back to work about 3 days after surgery. Many women who have this procedure done on a Thursday or Friday return to work on Monday. If you have sick time available, a week would be plenty of time to recuperate. You should be back to normal activities by 2-3 weeks.

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