Implants for augmentation may be inserted into the breast through one of the various types of surgical incision:
- Inframammary - below the breast fold
- Periareolar - areolar border
- Transaxillary - armpit
- Transumbilical (TUBA) - navel
- Transabdominoplasty (TABA) - navel
- Areolar Vertical Approach (AVA) - areolar border
The incision is made below the breast where it meets the chest at the inframammary fold. This incision is the most common approach in the UK. It is often the preferred technique for silicone gel implants due to the longer incisions being required in order to fit the implants. Inframammary incisions make the placement of the implant relatively easy. With this incision, the scars are often hidden due to the fact that the breasts cover them. Sometimes the actual scars can end up being quite thick.
The periareolar incision is made along the border of the areola (coloured circle of skin around the nipple). This type of incision is typically made when either adjustments to the inframammary fold position are required or a breast uplift (mastopexy) is required. The incision is generally placed around the bottom half of the areolar border.
Silicone gel implants can be difficult to place via this incision due to their size and the length of incision required, around 5cm. Scars from this incision occur on the edge of the areola and so they are often less visible than scars from inframammary incisions. The periareolar incision results in higher rates of capsular contracture.
The transaxillary incision is made in the patient's armpit and the surgeon continues towards the sternum. This incision allows good symmetrical results to be achieved with the breasts and also hides scarring since the incision is in the armpit. An endoscopes (a very small video camera that can be inserted the body) is sometimes used with this procedure.
A less common technique where the incision is made in the navel and the surgeon continues upwards towards the breast. This incision enables implants to be placed with no visible scars on the breast but the surgical procedure is more difficult and the implants are not as easy to place as with other procedures. This technique is typically reserved for saline implants as it is not easy to fit the more rigid silicone implants through the small 2cm incision. There would also be a risk of damaging the silicone implant shell.
The transabdominoplasty incision is quite similar to the transumbilical incision however it is more common. It is typically used when patients are having both abdominoplasty and breast augmentation within the same surgical procedure. The incision used for abdominoplasty is used.
Areolar Vertical Approach (AVA)
The areolar vertical approach is a very similar approach to the periareolar as the incision is the same. However, the AVA leaves a larger space for silicone implants. This has been shown to deliver strong results.