Dr. Kimberly Short, a female plastic surgeon in Indianapolis, IN reviews the four most common incisions used for placing breast implants.

Breast augmentation is the number one procedure she performs in her cosmetic surgery practice and Dr. Short uses three of the four most common breast incisions for placing breast implants in her practice.

After reviewing the options, her patients choose the inframammary crease incision (under the breast) most often and the periareolar incision second. The trans-axillary incision is the least common incision chosen by her patients. Dr. Short does not use the umbilical incision because she feels the limitations and the potential complications with this approach outweigh the benefit of removing the incision from the breast area.

Inframammary Crease Incision

The inframammary crease incision is the most popular incision for breat augmentation because the incision is not visible when looking straight at the breast (since it lies underneath the breast), even in a patient with minimal breast tissue. Also many patients are not comfortable with the idea of incisions around their nipples so they choose the inframammary crease incision. And there are only a few instances where this incision will not work well for a patient regardless of where the implant is placed or which type of implant is used.

Regardless of location, the incision will need to be large enough to allow creation of the pocket for the implant and for the implant to be placed. This means that it will be slightly larger for placement of a silicone implant as compared to a saline implant, since a silicone implant is pre-filled and a saline implant can be folded and placed into the pocket then filled after it is placed through the incision. This usually ranges from 3-5 cm.

Periareolar Incision

The size of the areola, therefore, may affect the decision whether this is the best incision to use. A very small areola is more likely to be distorted than a larger areola because the incision will need to encompass more of the perimeter of the areola to allow the appropriate length for the incision.

Another consideration regarding the periareolar incision, is whether a woman can express any milk from the nipple or she has breastfed recently. In either of these scenarios, the periareolar incision is not the best incision to use because of the risk of infection or contracture if milk is encountered in the glands during the surgery.
If a patient has a tubular breast shape, it may be necessary to relax the “constriction” around the areolar tissue during surgery so that the breast tissue fits nicely around the implant when it is placed. This would make the periareolar incision the best choice.

Also, if a breast lift is necessary, the periareolar incision is used for the implant placement because it will be needed for the breast lift anyway.

Neither the inframammary incision, nor the periareolar incision is more painful than the other.

Dr. Short will discuss the trans-axillary and trans-umbilical approaches in the next article.