When I read Internet discussions about breast augmentation incisions, the focus is always on the scar. "Which incision will give the best scar?" "Where's the best place to have the scar?" "Which is the easiest scar to hide?" All of these are reasonable concerns but, in truth, these are rarely the issues in choosing the incision.
There are 4 incisions that are currently used:
- Under the breast (inframammary)
- Through the nipple (periareolar)
- Through the underarm (transaxillary)
- Through the belly button (transumbilical or TUBA)
In most women, any of these incisions will leave a good scar. If the surgeon keeps the incision reasonably short and closes it meticulously, most will fade to a scar that is thin and relatively hard to see. Having done around a thousand breast augmentations, I can tell you that the scar is almost never an issue after this operation. Regardless of which incision I use. So if the scar isn't the issue in choosing the incision, what is?
The real issue is access and, specifically, access to the bottom of the breast. What we do in the lower breast (muscle fiber division, release of fibrous bands in the breast tissue) affects the roundness of the breasts, their perkiness, and the implant position. The closer the incision is to the bottom of the breast, the more fine control I have to execute these advanced maneuvers to shape the breast.
So when I make the incision under the breast or through the nipple, I have excellent access to the bottom of the breast. I can see the area directly. I can touch it to feel for tight spots that need to be released. I can do the most precise work to shape the best breast augmentation results. That's why the best incisions are under the breast or through the nipple.
If a surgeon uses the underarm approach, he can no longer feel the bottom of the breast. It's too far away. And unless he uses an endoscopic camera, he can't even see what he's doing. This really limits some of the fine control for shaping the lower breast.
The umbilical approach (TUBA) is even worse. This incision is so far away from the breasts that the surgeon has to pass a balloon on a stick up behind the breast and inflate it to make the pocket. Not very precise at all. Our goal is to create the absolute prettiest breasts possible for you. The inframammary and periareolar are the best incisions for doing that.