Effect of Incision Choice on Outcomes in Primary Breast Augmentation

If you are thinking about having breast augmentation, one of the factors that needs consideration is the site of the incision (where the cut in the skin will be created to place the implant through).
The options for the incision in breast augmentation are:

 

1. inframammary (in the fold underneath the breast)
2. peri-areolar (around the nipple)
3. trans-axillary (arm-pit)
4. trans-umbilical

 

The trans-umbilical approach has many drawbacks and is seldom performed. The trans-axillary approach has a scar that’s well hidden; however, this approach does not allow the surgeon as good an access to the breast when compared with the inframammary or peri-areolar approach.

 

In my practice, the inframammary and peri-areolar incisions are the most commonly used approaches for breast augmentation. They each have their pros and cons, and I would discuss these with the patient during our consultation, taking into consideration the patient’s personal preference. Both incisions give good access to the breast, both for primary as well as secondary procedures if they are ever required. Both incisions can heal up to become almost indistinguishable.

 

A study conducted in 2011 by Professor Scott Spears showed that the incidence of capsular contracture, which is scarring around an implant that can contract and cause symptoms, is highest with the transaxillary approach and lowest with the inframammary approach. One theory behind the cause of capsular contracture is bacterial contamination. The lower rate of capsular contracture with the inframammary approach may be related to the possible reduction in contamination by bacteria (theoretically, the the nipple or armpit can be a source of bacteria). The occurrence of capsular contracture can be unpredictable, and further studies on this condition are been carried out to determine ways of minimising their occurrence.

 

INCISION