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Breast Implant Incision Placement

 

Surgical placement of breast implants includes a number of incisions options.  The incision placement is decided on many factors, your own body type, the size of the implants being placed, and what the plastic surgeon is most comfortable with doing. 

 

                                          Breast Augmentation Incision Placements  

                                             Licensed image for CosmeticSurgeryForums.com

 

 

The inflamammary incision is placed in the fold under the breast, is the most common method with a breast augmentation procedure.  The incision is made underneath the breast fold or crease and is hidden by the breast over-hang.

 

  • PROS: 

Some surgeons feel that it allows more precision in implant positioning.  This incision can be very short between 1-1.5” inches wide when the surgeon is placing saline implants; however if the patient is going with large pre-filled silicone implants, then the larger the implant, the larger the crease incision.  

Saline has an advantage with how small the incision is going to be by the fact it goes in deflated and then the implant is filled from a port with saline once it has been placed.  The inframammary incision allows for placement easily with over the muscle, partially under, and full sub-muscular.  It also is the incision of choice when the plastic surgeon has to go back in for any complication, such as bottoming out, symmastia and capsular contracture

 

  • CONS:

There is a short, visible scar in the breast crease. If the patient decides to go larger, most of the time the plastic surgeon will have to lower the crease in order to center the implant completely behind the areola.  This means that the existing crease incision that was made might ride up higher in the breast mound due to the size increase with the implants. 

 

 

                                  Surgeon performing the inframammary incision - crease incision

                                              Licensed image for CosmeticSurgeryForums.com

                                    Surgeon performing the inframammary incision

 

 

 

The trans-axillary Incision is located in the arm pit.  This incision is highly specialized, and it is best to go to a plastic surgeon that performs this incision all the time.  Most plastic surgeons need to use an endoscope with placing the implants with this placement; however there are many skilled plastic surgeons that can do this incision blind (without the help of an endoscope).  Tunnels are made to the sites where the breast implants will be placed.

 

  • PROS: 

A shorter, less visible incision. Breast implants can safely be placed over the muscle, partially under the muscle, and full sub-muscular.  Many plastic surgeons consider this to be the best incision to use with full sub-muscular placement, as this incision will allow the plastic surgeon not to cut the fascia when placing the implants.

 

  • CONS:  

Difficult to have reliable symmetrical placement with placing the implants, due to the fact the surgeons are working so far away from the actual breast. 

 

                                        Trans-axillary Incision for Breast Augmentation

                                        Copyright 2010 - CosmeticSurgeryForums.com           

                                           Trans-Axillary Incision Placement

 

 

 

 

With the areola incision the implants are inserted through an incision at the lower perimeter of the areola (the dark skin surrounding the nipple).  This incision is the gold standard for masteopexy, as all breast lift incisions include the areola area.

 

  • PROS: 

Usually a very well hidden scar, as the areola heals incredibly well.  Both saline and silicone implants can be used with this incision, providing that the patient has a large enough areola to accommodate a pre-filled silicone implant.

 

  • CONS

Nipple or partial breast numbness is a potential side effect, but this can occur in any breast surgery regardless of the incision placement.  Though usually temporary, the loss of sensation could be permanent in some cases.  Additionally, if corrective surgery is necessary, plastic surgeons might have to use the crease to fix any potential complication.  If the patient’s areolas are very small, this will limit the size of the pre-filled silicone implant. 

There is also a greater risk of not being able to breastfeed with this incision, so it is best for patients who have already had their children.  Because of where this incision is located, near the milk ducts which are known to harbor bacteria - it poses the possibility of a Staph infection to occur. Most surgeons use a “sleeve” when inserting the implant with this incision, so that there will be protection against contamination. 

 

                                         Peri-Areolar Incision placement for breast augmentation

                                Copyright 2008 Nucleus Medical Art, Inc. - Used with permission

                          Breast Implant being placed through the Peri-Areolar Incision

 

 

 

 

 

This method of incision placement utilizes an endoscope to insert the implant through an incision on the belly button.  This method is highly controversial and public position statements by the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons caution against it.  Patient’s, who have used this method for breast augmentation however, tend to be very happy with their decision. 

The incision is made near the navel area, near the rim.  The surgeon uses an endoscope, and creates a tunnel right below the skin.  This tunnel starts at the navel/belly button area and leads up to the breast area.  The implant is rolled up and inserted into the tunnels - pushing the device up to the newly formed pocket that was made.  The implants are inserted flat and then once in place, saline is inflated using a fill tube inserted through the tunnel area.

 

 

                                  Trans-Umbilical Incision - TUBA - breast augentation

                                      Copyright 2010 - HowStuffWorks.com - Used with permission                         

 

 

  • PROS: 

The most inconspicuous scar, which is smaller than any other incision placement due to the elasticity of the skin on the abdomen.  Implants can be placed under or over the muscle with this incision, and the recovery tends to be a shorter duration of time versus the other methods.  There is a decreased risk of damage to the breast nerves since there are no incisions made on the breasts themselves.

 

  • CONS: 

Because the implant has a longer distance to travel when inserted in the body, there is more risk of complication.  Symmetry might not be even once the implants are placed due to the increase distance from the navel to the surgical site on the breast.  The tracks from the tunnels that were made with the endoscope might be visible on the abdomen right after surgery; however most of the time they do go away after a period of time – but some might leave a permanent mark.   Also, this incision placement is one that is technique dependent, so it is very important that you seek out a qualified plastic surgeon that has success with this method.

 

                                               

 

 

 

 

Trans-abdominal breast augmentation or TABA - is a procedure that combines a breast augmentation with an abdominoplasty procedure.  The plastic surgeon uses the abdominoplasty incision to perform the breast augmentation and insert the breast implants.   

 

The difference between TABA and TUBA:

  • TABA- Trans-abdominal Breast Augmentation

  • TUBA – Trans-umbilical Breast Augmentation

 

TUBA Incision Method

With the TUBA incision the implants are inserted with a tunneling device through the umbilical incision.  These tunnels are made to extend from the navel up to each breast, with using a balloon dissected.  The empty saline implants are inserted through these tunnels that have been made into the chest area – and once placed inside the pockets in the breast, the saline implants are inflated. Most of the implants inserted through the TUBA incision are placed over the muscle (sub-glandular)

 

TABA Incision Method

With the TABA Method - Trans-abdominal Breast Augmentation, no tunneling device is needed. The pocket for the breast implant is made with direct vision of the surgical area.  Patient has the choice of either sub-muscular (under the muscle) or sub-glandular (over the muscle) placement.  Patient also has the choice of either saline or silicone gel filled implants to chose from.

 

TABA Indications:

 

ADVANTAGES OF TABA METHOD:

  • Surgical costs are less because you are combining two procedures at the same time.

  • Less time is needed to perform both procedures

  • Hidden scar

  • Recovery time is normally the same compared to patients who had these procedures done separately

  • Surgeon has a better view of the surgical area with TABA

 

Photo of a patient who had the TABA Method

 

 

               Breast Augmentation Incision Placements

Copyright 2010 - CosmeticSurgeryForums.com

 

 

 

The Keller-Funnel technique is designed to facilitate the delivery of silicone gel implants during augmentation to help prevent any type of contamination that might occur with handling the breast implants during surgery. This device was designed by Dr. Kevin Keller who is a board certified plastic surgeon of Keller Medical in Stuart, Florida.

 

                                             Keller-Funnel - No Touch Technique with placing breast implants

                                                   Photo courtesy of Keller-Funnel

                                              Surgeon using the Keller-Funnel


The Keller Funnel is used specifically to improve delivery of silicone gel implants during the procedure of breast augmentation.  The device is intended to assist with the delivery of pre-filled implants by providing a low friction shell-tissue interface during implant insertion using a no-touch technique to prevent contamination.  Some plastic surgeons believe that any kind of contamination to the implant before insertion can contribute to capsular contracture in a patient.

Once the implant is placed inside the funnel during surgery, the surgeon places the small distal end into the prepared breast pocket and using a pushing/squeezing motion easily propels the implant into place.



Benefits of the Keller-Funnel:

  • Shorter incision lengths - with placing a larger implant through a smaller incision

  • Improved comfort and faster healing - less trauma to the patient's tissues during insertion

  • No touch technique - allows placement to occur without the implant having to touch anything else in the operating room - including even a surgeon's own gloves

  • More choices for incision placement - Trans-ax, peri-areolar and inframammary

  • Reduced force on the implant and incision - reduces the risk of damage to the implant during insertion (such as deflation)
     

The Keller-Funnel successfully can place up to 800cc silicone implants - and can be used in trans-axillary incision, peri-areolar incision and inframammary or crease incision.

 

 

 

 

 

 

 

 

 

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