Breast Surgery Incision Options

When we talk about breast incision options we really have to be a bit more specific about exactly what breast operation we are talking about. Some incision choices in breast surgery will be dictated by the type of surgery we are doing, while other breast incisions can be totally optional depending on the patient and the surgeon.

For example, the type of breast incision used in a breast lift or mastopexy operation will be dictated in large part by the type of lift the woman may need. This can range from an incision just around the areola for a donut mastopexy or “mini” breast lift all the way to the full “anchor-type” incision used in a full Breast Lift or Mastopexy. In my practice, I always try to use the smallest incision needed to get the job done, but one of the biggest challenges I see is when a woman comes into my office and presents with very saggy, droopy breasts and desires enlargement to lift her breasts and yet at the same time, does not want any lift type incisions or scars. At times, there is a misconception that implants alone will correct an abundance of droop!!! But they don’t. So in a Breast Lift situation, it really depends on the amount of breast droop or breast ptosis, that a woman has and what her ultimate goals are as well. A patient may be willing to accept a bit more droop after surgery and elect to have the Donut Lift, understanding that the trade off may be a bit less fullness at the top of her breasts.

Now, when talking about straight-forward breast augmentation, there may be a bit more flexibility in breast incision choice. The three most common incisions in breast augmentation are:

• the peri-areolar incision, placed at the color change that most women have between the areola and the skin of the breast
• the Infra-mammary incision that is placed underneath the breast where the natural fold is
• the trans-axillary incision that is in a crease of the underarm.

They all have pros and cons, all can be used with silicone or saline implants, and there is almost always a surgeon preference as well. With the first two methods, the peri-areolar and the infra-mammary breast incisions, they are well hidden under clothing. The downside is that there has to be an incision made as well in the breast tissue itself to be able to place the implant in its proper location. That tunneling through breast tissue has the potential of causing scar tissue in the breast itself and severing some breast ducts and/or nerves. In the far, far majority of cases this is not a problem. With the underarm approach, because access is gained to the sub-pectoral or under-muscle space from the underarm, there is no disruption of the breast tissue itself, no tunneling through ducts or nerves and no potential breast scar tissue left behind. An endoscope or camera is often used to aid in visualization when creating the space for the implant and adjusting the pectoralis muscle. Some women worry that this transaxillary incision may be seen when raising the arm, but because it fades so well, that is almost never an issue.    

If you would like more information about breast surgery incisions, contact our Scottsdale breast surgeon, Dr. Corey for a personalized consult and evaluation.  Serving patients throughout Scottsdale, Phoenix, Gilbert, Chandler, Mesa, and Tempe, Arizona.