This is one of the most frequently asked questions during a breast augmentation consultation at my Nuffield Warwickshire Cosmetic Surgery Clinic. The breast augmentation operation is the most popular cosmetic surgery procedure in the UK, favoured by younger women who are unhappy with their lack of breast development or older women, who may have seen changes to their breast size, shape and volume as a result of pregnancy, breast feeding, weight fluctuations or the effects of gravity.
The good news is that breast augmentation incisions usually heal well and are positioned so they are often quite difficult to detect once fully healed. Theoretically, there are four incision approaches that can be used during a breast augmentation procedure and there are benefits and limitations to each.
The patient’s frame and amount of existing tissue is taken into account as well as the type and size of implant to be used and where it will be placed. For example, polyurethane-coated implants (use currently suspended which I’ll be taking a look at in next month’s blog) needed a longer incision than the smooth or textured surfaced implants, as they are more difficult to insert and to position. Once I have taken into account all these factors, I can advise patients on which is the best incision approach for them.
These four breast augmentation incisions are:
1. Inframammary incision
This is by far the most commonly used breast augmentation technique, with the incision made where the bottom of the breast meets the body. Once the implant has been inserted, the scar usually ends up very slightly above the inframammary crease but still well concealed on the undersurface of the breast and when wearing a bikini.
Pros of this technique are that it allows easiest surgical access , allowing most accurate implant positioning, and it may cause less difficulties with future breast feeding. It is also my preferred approach.
2. Periareolar incision
In this approach, an incision is made around the edge of the areola (the coloured area around the nipple), so that the scar is more or less ‘camouflaged’ in the change in colour and texture between the areola and the breast. Deep to the incision, access continues through the breast tissue, which may mean a higher chance the patient will not be able to breast feed in the future (although breast feeding is not always possible even for women who haven’t undergone cosmetic breast surgery). It can also affect sensation in the nipples and breasts as the nerves can be damaged during this approach.
Access is less easy than with the inframammary incision and I only ever agree to use it for relatively small implants. If you have a light-coloured areola area then the scars will be more visible.
3. Transaxillary incision
This incision is made in the armpit, allowing access to the chest muscle. However, the incision point is a long way from the inner part edge of the breast and the risk is that too lateral a pocket will be created, producing a less than optimal appearance.
Once again, unless a small implant is placed, the scar may be quite obvious, particularly when the arms are raised. Scarring in this area tends not to fade as well.
4. Periumbilical incision
During this procedure, an incision is made in the edge of the belly button. Personally, I have never performed this approach. A long way tunnel has to be developed to the placement site, making accurate siting more difficult and with a greater chance of implant damage during insertion. Additionally, bleeding is more difficult to control.
How to improve scarring after a breast augmentation
Normal scar maturation takes approximately a year. Typically, you can expect the colour to go from red to pink to pale in Caucasians but it may stay pinkish or even slightly purple. In Asian or black skin, the scar colour may end up paler, the same or darker than adjacent skin. Scars may stretch sideways and therefore not end up in an absolutely fine line.
I recommend that my breast augmentation patients massage the scars daily with a hydrating cream, such as E45, Cetraben or Diprobase, for at least a few months. BioOil, known by so many through well directed marketing and the catchy name, can also be used if desired.
It is essential to wear a postoperative surgical bra (external link:www.royce-lingerie.co.uk) to support the whole bust area for up to three months after your procedure, as, quite apart from controlling swelling and early natural healing round the implant, it can also help prevent scar hypertrophy, where the scars can thicken and ridge. Application of topical silicone gel strips, such as Mepiform or Cicacare and/or the rubbing in of silicone-based ointment, like Kelocote or Dermatix, for several months may also hasten improvement in scar hypertrophy.
True keloid scar formation, where thickening and ridging of excess raised scar tissue occurs, progressively extending out beyond the line of the original scar, is most common in black skin and is very uncommon in Caucasian patients. It is notoriously difficult to treat if it occurs; steroid injection into the scar tissue can sometimes be helpful, together with the use of pressure garments if possible. I have never seen true keloid formation in a breast augmentation scar.
Any surgical procedure will result in scars, but it is important to understand that they are a necessary accompaniment for positive change. No scars equals no change: when that is accepted and understood, it is possible to properly focus on the new shape and appearance of the breasts.