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Incision Sites

Incision sites are another consideration when planning a breast augmentation. The most commonly performed incision site is the infra-mammary area. This incision can be at the level of the infra-mammary fold, slightly below the infra-mammary fold, or slightly above the infra-mammary fold. When the incision is placed at the level of the fold, patients will sometimes state that the scar is painful when their bra is resting on it. Incisions above the infra-mammary fold are better concealed in two piece bathing suits but these scars may be wider than scars at or below the infra-mammary fold. Studies have shown that tension on a wound in the early healing phases can cause the scar to widen and become less favorable. When the incision is placed above the infra-mammary fold, the implant that is stretching the skin also stretches the incision site, which can cause scar widening in some patients. If the incision is placed slightly below the infra-mammary fold, it is less likely that there be will scar widening, but the scar may be more visible in some clothes or bathing suits.

The advantages of the infra-mammary site include favorable scarring (in most patients), avoidance of internal scar in the middle of the breast, technical ease of surgery, technical ease of surgical revision (if needed), ease in intra-operative bimanual breast exam, and direct visualization of the breast pocket in continuity. There is also some evidence that the infra-mammary incision has the lowest rate of problematic capsule formation. This is theoretically a result of less injury to the breast ducts which are largely avoided with the infra-mammary incision. The infra-mammary incision is generally inconspicuous and does not interfere with breast feeding. The peri-areolar incision (around the nipple area) goes directly through the breast gland and therefore causes scarring inside the gland. Theoretically this could complicate and make reading mammogram studies more difficult as a result of the internal scarring. The peri-areolar incision theoretically could make breast feeding more difficult because of the damage of the breast glands, the breast ducts, and the nipple areolar-complex. If using silicone breast implants, the peri-areolar incision may not be large enough to allow introduction of the implant into the breast pocket. The peri-areolar incision is also more challenging in patients with a thick breast plate which results in more tissue dissection. Because the incision is in the middle of the breast mound, the peri-areolar scar may be more visible than other incision sites. Many breast augmentation surgeons believe that the disadvantages of the peri-areolar incision outweigh the advantages when compared to the infra-mammary incision. The axillary incision (armpit) has also been used for the augmentation mammaplasty procedure. This incision is remote from the breast pocket which can make the procedure more difficult and preclude an intra-operative bimanual breast exam. Studies have shown a higher rate of post-operative asymmetry using the axillary incision, presumably because pocket access is less favorable. The axilla is heavily laden with hair follicles, sweat glands, and oil glands, which could cause wound healing problems after breast augmentation. The axillary incision may also be more visible in some types of clothing including bathing suits and sleeveless clothing. Some surgeons also have concern that the location of the axillary incision site is near a major lymph node basin which may cause problems with cancer detection and/or treatment. Other incision sites have been used for augmentation mammaplasty, such as the trans-umbilical (belly button) technique, but these other sites have not gained wide acceptance for a multitude of reasons.