Photo courtesy of preciouskhyatt, flickr.comLast week we answered a couple frequently wondered questions regarding boob jobs, or more clinically speaking, breast augmentation. Now let's tackle some more technical aspects of what it takes to make smaller breasts bigger.
Breast augmentation, is of course, surgery. This may seem self-explanatory, but I really can't emphasize this point enough. You shouldn't be able to walk into a doctor's office for the first time and on the same day walk out with bigger boobs. Cosmetic surgery though it is, breast augmentation still requires a careful history-taking and physical examination by a skilled surgeon long before anything goes up a cup size or two.
Questions (like these) should be asked and answered. Another key point is the placement of the incision or scar. There are several options these days, as you can see in my illustration below.
1. Transaxillary. This is the "armpit scar" - a small incision is made in one of the creases of the armpit, and a tunnel is made to the breast area to allow for placement of the implant. Sometimes a small video camera is used to help see the creation of the pocket where the implant will live; sometimes not.
Some patients and surgeons like this approach because it does not leave any scars on the breast. Instead, you have your scar in a fairly inconspicuous location (hopefully, no one's looking that closely in your armpits).
The downside of the transaxillary technique is that it is a remote approach to the breast; some surgeons feel that fine control over placement of the implant is not as precise. Also, if you need a revision for any reason after a transaxillary breast augmentation, it is very difficult to use the same incision - which means that you might end up with a scar on your breast anyway.
2. Periareolar. A lot of folks commonly refer to this incision as the one that "goes around the nipple", which isn't quite accurate. The incision is made skirting the underside of the areola, the pigmented area around the nipple. Many patients prefer this scar, because they think that it will be well hidden in that area of color change. Many surgeons prefer this approach because it offers direct access to the breast for the implant placement.
Personally, I'm not a big fan of the periareolar incision. I think that the scar is often more obvious when placed around the areola - it often heals to become either lighter or darker than the surrounding breast skin or the areola. Also, the border of the areola is very indistinct if you look at it closely. It's neither a straight line or perfect circle; our incisions are either lines or arcs, which makes it easy to spot from across the room.
One more downside to the periareolar incision: because you're cutting through breast tissue so close to the nipple, you run a slightly higher risk of interfering with sensation and breastfeeding potential.
3. Inframammary. This incision is hidden beneath the breast, just above the bra-line. Patients like it because a well-placed scar ensures that no one sees evidence of their surgery, unless they're peering underneath their breasts with a flashlight and magnifying glass. Surgeons like it because it offers great access to the space where the implants go.
Personally, the inframammary approach is my favorite, for the abovementioned reasons.
4. Transumbilical. This technique was developed and championed more recently, as plastic surgeons attempted to find a "more perfect" approach for breast augmentation. You may have seen it on those reality TV shows or marketed as the "TUBA" technique. The incision is placed in the belly button, which is a great place to hide scars. Unfortunately, you face similar limitations as the transaxillary technique and are tunneling implants quite a distance; this approach never lived up to expectations, and I don't know of any respected plastic surgeons who routinely perform breast augmentations this way.
Next week, we'll take a closer look at where those implants actually go. More questions? Email them to me at AngelineLimMD [at] DuetPlasticSurgery [dot] com.
