The Importance of Incision Choice
Before any breast procedure, selecting the right incision type is a collaborative decision between you and your surgeon. This choice affects scar visibility, the surgeon's access to the breast pocket, the potential for nipple sensation changes, and the ability to breastfeed after surgery. Factors influencing this decision include the specific procedure (augmentation, reduction, or lift), the desired implant type (saline or silicone), the implant size, and your personal anatomy and skin quality. With modern surgical techniques and careful planning, incisions are often strategically placed to be as inconspicuous as possible.
Incisions for Breast Augmentation
For patients undergoing breast augmentation, the most common incision options are designed to conceal scars while providing optimal access for implant placement..
Inframammary Incision (Breast Crease)
This is one of the most common and versatile incision types, placed in the natural fold beneath the breast where it meets the chest wall.
- Advantages: Offers the surgeon excellent visibility and control, leading to precise implant placement. The scar is easily hidden by the natural breast crease, a bra, or a swimsuit. It is suitable for both saline and silicone implants and can be reused for future revision surgeries. It also presents a lower risk of affecting milk ducts, preserving potential breastfeeding ability.
- Disadvantages: The scar, while typically fine, can be visible when lying down or if a patient's natural crease is poorly defined. If significant changes in implant size are made during a revision, the scar's position relative to the fold could change.
Periareolar Incision (Around the Nipple)
With this technique, the incision is made along the edge of the areola, where the darker tissue meets the lighter breast skin.
- Advantages: The scar can be well-camouflaged by the natural pigmentation and texture difference of the areola, often making it virtually invisible. It provides good access for precise implant positioning.
- Disadvantages: It is not an option for patients with small areolas, as the incision needs to accommodate the implant size. There is a slightly increased risk of nerve damage, which can affect nipple sensation. Studies have also suggested a higher rate of capsular contracture associated with this method, though risks are low in general.
Transaxillary Incision (Armpit)
This approach places the incision in the natural crease of the armpit, completely avoiding any scars on the breast itself.
- Advantages: The main benefit is the absence of scars on the breast, which can be appealing for patients. The risk of damaging milk ducts is minimized, making it a good option for future breastfeeding.
- Disadvantages: The surgery is performed endoscopically, meaning a tunnel is created from the armpit to the breast pocket. This can potentially lead to less precise implant placement, a slightly higher risk of asymmetry, and is more dependent on the surgeon's specialized skill. While silicone implants can often be used, the approach is sometimes limited to saline implants, depending on the surgeon's technique and implant size. The underarm scar may be visible when wearing sleeveless clothing.
Transumbilical Incision (Belly Button)
This less common technique involves making an incision inside the belly button, creating a tunnel to the breast.
- Advantages: Leaves no scars on the breasts, areolas, or armpits. Some patients report faster recovery and less pain.
- Disadvantages: This approach is primarily used for saline implants, as silicone implants are too large to insert. It offers the least surgical control and has a higher risk of malposition and asymmetry. Revision surgery through this incision is not possible, requiring new incisions on the breast if needed.
Incisions for Breast Reduction and Lift
For procedures like breast lifts (mastopexy) and reductions, different incision patterns are used depending on the amount of tissue to be removed and the desired lift.
Lollipop (Vertical) Incision
This incision involves a circular cut around the areola combined with a single vertical incision from the bottom of the areola down to the breast crease.
- Usage: Suitable for patients with moderate breast sagging and excess skin who require a significant lift and reshaping. It offers a good balance between access and minimized scarring compared to the anchor incision.
Anchor (Inverted T) Incision
This technique uses the lollipop incision pattern but adds a horizontal incision along the breast crease, creating an anchor or inverted T shape.
- Usage: Ideal for patients with significant sagging (ptosis) and those requiring substantial breast reduction or reshaping. It allows for maximum skin and tissue removal but results in a more extensive scar pattern.
Crescent Incision
A small, rainbow-shaped incision is made along the upper half of the areola.
- Usage: Used for very minimal lifting or reshaping when only a small amount of skin needs to be removed. It results in the least amount of scarring but has limited utility.
Comparison of Common Incision Types
| Feature | Inframammary Incision | Periareolar Incision | Transaxillary Incision | Anchor Incision | Lollipop Incision |
|---|---|---|---|---|---|
| Primary Use | Augmentation | Augmentation, Minor Lift | Augmentation | Reduction, Significant Lift | Reduction, Moderate Lift |
| Scar Location | Breast crease | Areola edge | Armpit | Areola, vertical, crease | Areola, vertical |
| Scar Visibility | Well-hidden, may show when lying down | Very well-hidden | Hidden on the breast, may show in sleeveless tops | Most visible, but necessary for significant changes | More visible than periareolar, less than anchor |
| Surgical Control | Excellent and precise | Excellent | Can be less precise, depends on skill | Excellent, maximizes access | Good, allows for significant reshaping |
| Implant Compatibility | Saline and silicone | Saline and silicone | Primarily saline, silicone for some | N/A (for reduction) | N/A (for reduction) |
| Breastfeeding Risk | Low | Slightly higher | Low | Can disrupt milk ducts | Can disrupt milk ducts |
| Sensation Impact | Low risk | Slightly higher risk | Low risk | Variable | Variable |
Scar Healing and Minimization
Regardless of the incision type, scarring is a normal part of the healing process. The final appearance of scars depends on genetics, skin type, surgical technique, and postoperative care.
Best practices for scar care include:
- Follow Post-Op Instructions: Meticulously adhere to your surgeon's specific wound care instructions to prevent infection.
- Silicone Products: Once the incision is fully healed, applying silicone sheets or gel can help flatten and soften the scar.
- Sun Protection: Scars are sensitive to UV rays, which can cause permanent darkening. Protect new scars from the sun with clothing or sunscreen.
- Gentle Massage: Massaging the healed incision area can soften scar tissue and improve circulation.
Conclusion
Choosing the right breast surgery incision is a decision that balances cosmetic preference with surgical and anatomical realities. While incisions like the inframammary and periareolar are popular for augmentation due to their ability to hide scars, procedures like breast reduction often require more extensive patterns like the lollipop or anchor to achieve the desired result. Factors such as implant type, size, and individual anatomy all play a role. The most important step is a thorough consultation with a board-certified plastic surgeon to understand all your options and make an informed choice that aligns with your goals. Proper wound care and scar management are essential components of the healing process, ensuring the best possible long-term aesthetic result. For more information, consider a consultation with a qualified plastic surgeon or visit reputable sites such as the American Society of Plastic Surgeons.
