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.
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.
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
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,
and capsular contracture.
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.
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.
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.
to havereliable symmetrical placement with placing the
implants, due to the fact the surgeons are working so far away from
the actual breast.
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.
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
pre-filled silicone implant.
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
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.
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.
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.
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.
augmentation or TABA - is a procedure that combines a breast augmentation with
procedure. The plastic surgeon uses the abdominoplasty incision to perform the
breast augmentation and insert the breast implants.
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
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)
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
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
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.
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