Breast Implants and Incisions

Four major approaches are used to place breast implants. Each has good points as well as negative features. Generally, the smaller the incision, the less we have to worry. Be sure to ask your plastic surgeon how long they make the incision. At the Mandell-Brown Plastic Surgery Center in Ohio, we strive to make the incision as small as possible.

Under the Breast (Inframammary)
This is the traditional approach used nation wide. It provides the most direct access to the breast pocket. It is also the approach used to handle most complications.

We use a 2.5cm (one inch) incision for saline implants and a 5 to 6cm incision for silicone implants. Once, while on a panel discussing breast incisions, a plastic surgeon from New York City responded that he always makes it 6 to 7cm (3inches).

That was obviously how he was trained, so he did it the same way. He did not believe that we use much smaller incisions or that it was even possible!!

A drawback to this approach is the fact that you will always have an incision under the breast. Usually, the incision heals fine, but occasionally, it can leave slightly darker pigmentation along the incision. Unless you intend to be a Magazine Model or Exotic Dancer most will never know.

Around the Areola (Periareolar)
The incision is made around the areola or central colored part of the breast. The incision is typically made from 3 o’clock to 9 o’clock. This approach provides direct access to the breast pocket, but the surgeon must separate the breast tissue to develop a pocket for the breast implant. The incision usually heals beautifully, but if not—there is a scar on the central breast and not underneath it like in (1). To help the scar, if it is lighter, micro-pigmentation or permanent coloring can be placed. If the scar is slightly raised, microdermabrasion can help smooth the scar.

At the Mandell-Brown Plastic Surgery Center, we often use this approach when a breast lift is needed as well. Some of the excess sagging skin can be removed and an implant can be placed at the same time.

See breast lift section.

Armpit (Trans-axillary approach)
The Trans-axillary approach is becoming more popular. The incision is made in the axilla or armpit. The incision is hidden in a natural armpit crease. The pocket is then made over or under the muscle and the implant is placed through the axilla.

Occasionally the scar can be noticeable especially if you wear tank tops or sleeveless shirts. Rarely hand weakness or arm numbness results. At the Mandell-Brown Plastic Surgery Center, we believe it is up to the patient which approach is used. Benefits and risks of each approach is discussed in detail to help the patient select which is best for them. The days where “THE DOCTOR KNOWS BEST” are long gone. We feel we have a partnership with the patient and ultimately it is the patient’s choice.

Navel (Trans Umbilical Approach)
This approach is more popular in Florida, California, and Texas. As seen in Dr 90210, an incision is made at the belly button (navel or umbilicus) and a tunnel is made toward the breast.

A metal tube is inserted from the navel to the breast and with special instruments a pocket is developed. Only saline implants can be used since they are placed deflated and rolled into a “taco shell”. A plunger pushes the implant into the pocket and a long fill tube is used to add the saline. After filling the same process is repeated through the same incision toward the opposite breast.

Although one incision is made around the belly button the drawbacks with this approach include: only saline implants can be used and it is better suited to place the implant sub-glandular instead of under the muscle. We are excited to announce that the Mandell-Brown Plastic Surgery Center is now the only Tri-State facility offering this approach.

Be sure to check out our photo gallery! If you would like more information about any type of breast implant procedure, please contact us today for an initial consultation.