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

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

In her last blog, she discussed the two most common incisions her patients choose for their breast augmentations, the inframammary crease and the periareolar incisions.

There are several other incisions, which can be used for placement of breast implants. These include the trans-axillary (armpit) incision and the umbilical incision.

Both of these approaches are less popular than the inframammary crease or periareolar incisions. Both approaches require the placement of saline implants and are used less frequently as surgeons have shifted toward using more silicone implants.

Trans-axillary incision

The trans-axillary approach became popular because the incision could be removed from the breast area altogether. If the incision does not heal well, it can, however, be the most noticeable of the incisions. This incision can be visible even in a tank top or a sundress. Fortunately, the incisions for breast augmentation all typically heal well in any of the locations and are usually inconspicuous after a number of months.

With the trans-axillary incision, the implant is placed under the muscle and it is necessary to lift the upper border of the pectoralis, which is not done with the other incisions. This can allow the implants to stay positioned higher than desired making massage very important in assuring that the implants settle into the right position. Some surgeons also feel that this approach is more painful after surgery because of the more extensive elevation of the pectoralis muscle.

Trans-umbilical approach (incision through the navel or belly button)

The umbilical incision is the least often used incision for breast augmentation. It is not possible to visualize the pocket through this incision so the pocket is created by the placement of the implant. It is more difficult to control any bleeding which occurs and many surgeons feel that bleeding around the implant even if it is limited will increase the risk of contracture.
In addition, it is difficult to correct asymmetries or make changes in the implant position through this incision. Finally, patients can develop scar tissue “cords” from the placement of the “tubes” from the umbilicus to the breast. These can become firm and visible especially in a patient who is thin. The limitations and potential complications of this approach make it less than ideal for most women, especially since there are other good alternatives.

Dr. Short feels the disadvantages of the trans-umbilical approach outweigh the benefit of having an incision, which is not on the breast. She does not offer the umbilical incision as an option for her patients.