Breast Augmentation Incisions and Scars

All Breast Augmentation techniques use a small incision to insert the implant. The incision can be made in one of four places:

  1. Breast fold (Infra-Mammary Breast Augmentation)
  2. Areola (Peri-Areolar Breast Augmentation)
  3. Armpit (Trans-Axillary Breast Augmentation)
  4. Belly button (Trans-Umbilical Breast Augmentation)

A permanent scar remains after surgery where each incision was placed. Dr. Jugenburg is an expert at creating minimal scars that are beautifully concealed and virtually undetectable. The technique that is chosen for your surgery will therefore depend on:

  1. Your existing breast anatomy
  2. Personal goals
  3. The content of your breast implants (saline or silicone)
  4. The profile and size of your breast implants
  5. The intended position of your breast implants (above or below the chest muscle)

It is possible that your breast enlargement may be suitable for more than one approach, in which case, you will be able to decide where you would prefer your scars to be concealed.

Trans-Axillary Breast Augmentation

An incision is made in the armpit and a tunnel is then created into the space (the breast pocket) under the chest muscle. This approach is the best way to hide the scars; there are no scars on or under the breasts, and the scar in the armpit heals beautifully to a point where it is undetectable to the naked eye. For this reason, the Trans-Axillary technique can be described as a virtually scarless Breast Augmentation and is the preferred approach of Dr. Jugenburg.

Advantages:

  1. No scar on or under the breast.
  2. Scar often blends into the armpit crease and is very hard to detect.
  3. Usually the least visible of augmentation scars.
  4. No muscle is cut; only natural tissue planes are opened up to insert the implant
  5. No breast tissue is injured and there is therefore no possible effect on breastfeeding.
  6. Implants can be inserted under the chest muscle (sub-muscular or sub-pectoral), which is associated with a lower risk of Capsular Contracture, bottoming out and  visible implant rippling/wrinkling.

Disadvantages:

  1. Going over the muscle (sub-glandular or sub-mammary) is not an option.
  2. Saline implants of any size can be used, but silicone implants only up to a certain size can be gently tunnelled into the pocket below the muscle.
  3. The longer (2 – 2.5 inches) scar needed for placement of silicone implants can be difficult to hide in small underarms.
  4. Additional surgery, such as removal of excess scar tissue from around the implant  (Capsulectomy), may be difficult with this approach. (This should not be a determining factor as the risk of a Capsular Contracture forming that requires surgery is very rare).
  5. Very small risk of numbness of the skin around the underarm and upper arm.
Transaxillary Breast augmentation scar
Ideally healed transaxillary scar looks like a wrinkle in the armpit

Peri-Areolar Breast Augmentationimg2

A small incision is made around the lower border of the areola. This is an effective way to conceal the scar, especially in women who have a more pronounced contrast between the color of the areola and skin.

Peri-Areolar surgery is preferable in women who do not have a well defined breast fold and in whom an Infra-Mammary incision would therefore be difficult to hide.

Advantages:

  1. Direct visibility of pocket creation and implant positioning.
  2. Scar can be well hidden by areolar tissue and color contrast.
  3. Good approach for additional breast surgery.
  4. Good approach for treatment of cases of mildly sagging breast (i.e., a small Breast Lift).
  5. Best way to hide the scar when using larger silicone implants.
  6. Implants can be placed above or below the chest muscle.
  7. Compatible with the Bloodless Breast Augmentation technique, perhaps thereby further minimizing the risk of Capsular Contracture formation.

Disadvantages:

  1. Scar is at the focal point of the breast.
  2. Procedure is carried out through a highly sensitive area of the breast.
  3. Some sensory nerves around the areola are cut (however, there is no evidence to suggest that a greater risk of loss of nipple sensation exists with this approach).
  4. Some breast tissue, including milk-producing glands and ducts, must be cut in order to reach the pocket into which the breast implants are placed. However, since only a very tiny portion of the breast gland tissue is affected, breastfeeding ability will most likely not be affected (further information is given here).
periareolar breast augmentation scar
PeriAreolar breast augmentation scar seen 2 years after surgery

Periareolar scar seen after 4 years. Over time the skin discoloration around the actual incision faded, and the incision itself is a very fine barely visible line.

img3Infra-Mammary
Breast Augmentation

A small incision is made within the breast fold, providing direct access and easy implant placement into the pocket either above or below the chest muscle.

This is the most popular approach to Breast Augmentation (for women having a well defined breast fold).

 

Advantages:

  1. Direct visibility of breast pocket creation and implant positioning.
  2. In women with deep folds, the scar is hidden by the breast.
  3. Good approach for additional breast surgery.
  4. Good approach for treatment of cases of mildly sagging breasts.
  5. Excellent access for placement of silicone implants.
  6. Compatible with the Bloodless Breast Augmentation technique, perhaps thereby further minimizing the risk of Capsular Contracture formation.
  7. No breast tissue is injured through this approach and there is therefore no possible effect on breastfeeding.

Disadvantages:

  1. Scar under the breast.
  2. Hard to hide scar on small, tight breasts, without deep folds.
  3. Scar may be visible when you are lying flat.

#tinyscar breast fold incision is the smallest possible incision for breast augmentation

An example of a slightly thickened, raised breast fold scar. It will benefit from Kenalog injections.

Trans-Umbilical
Breast Augmentationimg4

A small incision is made inside the belly button. A narrow tube is then temporarily placed under the skin towards the breast, through which a surgical instrument is inserted to create the pocket for the implant. A saline implant is then folded up and inserted through the tube into the pocket under the breast.

Dr. Jugenburg does not perform this approach because of its obvious limitations.

Advantages:

  1. No scar on or under the breast.

Disadvantages:

  1. Precise creation of breast pocket and implant positioning difficult, which gives the least amount of control over shaping the breast.
  2. Precise control of bleeding difficult.
  3. Silicone implants cannot be inserted though this approach.

Breast Implant Scars FAQ

  • Silicone breast implants, which come in pre-filled profiles and sizes, require longer incisions than saline implants, which can be filled after insertion under the breast area (i.e., once inside the breast). Larger silicone implants can be problematic for the Trans-Axillary approach; however, this will depend on the anatomy of each patient.

  • All Breast Augmentation procedures are performed using the No-Touch Technique. Using this technique, breast implants are transferred from their sterile packaging directly into the breast pocket to minimize the risk of bacterial contamination and therefore, Capsular Contracture formation. For further information, please refer here.

  • The Bloodless Breast Augmentation technique, which is believed to lower the risk of Capsular Contracture, is useful for surgery performed through the areola (Peri-Areolar) or breast fold (Infra-Mammary), but is not compatible with surgery performed through the armpit (Trans-Axillary). For further information, please refer here.

  • In addition to Dr. Jugenburg’s expertise at creating beautifully concealed, virtually undetectable scars, we offer the silicone-based skin gel Kelocote to all our patients. Although vitamin E, Bio-Oil and other products are available over the counter, silicone creams and gels are the only substances shown to be effective in scientific studies.

  • The average length of incision is 3 – 4 cm (1 – 1.5 in), but the length of your scars will depend on your chosen breast implant profile, size and type. Saline implants of all sizes typically require very small incisions, whereas silicone implants require longer incisions and a skilled Plastic Surgeon, such as Dr. Jugenburg, to effectively conceal them.

  • Following surgery, Breast Augmentation scars are red and normally a little raised, but over 3 – 6 months they usually fade and flatten out, becoming thin, barely visible lines. For all incision placements, the scars are usually beautifully concealed within the natural contours of a woman’s body.

  • All scars are visible initially following surgery.

    Past scarring from previous injuries and/or surgeries may be indicative of how prone an individual may be to visible scarring and can influence the decision on where best to make the incisions during Breast Augmentation surgery.