Breast Augmentation Techniques

During a breast augmentation the breast implants be placed via various types of incisions. The main four breast augmentation techniques are:

• Under the breast (inframammary breast augmentation)
• Around the areola (periareolar breast augmentation technique)
• Under the arm (transaxillary breast augmentation)
• Through the belly button (transumbilical breast augmentation, or TUBA)

Two less common techniques are transabdominoplasty breast augmentation and areolar vertical approach.

Inframammary Breast Augmentation Technique

The most common breast augmentation technique is the inframammary technique, which inserts the implant in the fold where the breast meets the chest wall. This breast augmentation technique leaves no visible scars, but it can leave slightly more visible or thicker scars than other breast augmentation techniques.

The inframammary breast augmentation technique gives the breast augmentation surgeon maximum access for precise dissection and placement of an implant. This breast augmentation technique is often preferred for silicone gel implants because of longer incisions required.

A major benefit of the inframammary option is that women of childbearing age experience less difficulty breastfeeding after breast augmentation because neither the glandular tissue nor innervation is affected. However, if the breast implant is placed on top of the pectoral muscle, it can exert pressure on the ducts and glands, which might reduce milk production during breastfeeding.

Periareolar Breast Augmentation Technique

The scar from a periareolar incision-the colored circle of skin around the nipple-is virtually invisible, as it blends well with the natural pigment and change in skin color. In addition to being the most easily concealed incision, the periareolar option has several other benefits: It allows the surgeon to place implants under the muscle or under the glandular tissue, as with inframammary incisions (under the breast). Surgeons like periareolar incisions because they give the greatest degree of precision because of the proximity to the treatment site. If post-operative complications occur after surgery, an additional incision will not typically be required. The surgeon can enter through the original incision, eliminating the risk of added scarring from corrective surgery.

This breast augmentation technique carries more risk that relate to milk production than other breast augmentation techniques. Ducts and glands have a high risk of being damaged because the incision penetrates deeply through the breast tissue. If the breast implant is placed above the muscle, it can further impede milk production by placing pressure upon the glandular tissue.

Silicone gel implants can be difficult to place because of the length of incision required for access.

Transaxillary Breast Augmentation Technique

The transaxillary breast augmentation technique requires placement of an incision in the extreme upper, outer region of the breast near the juncture of the arm to the torso (arm pit), which minimizes visible scarring. The incision is generally invisible even with the arm raised, but it is more likely to produce asymmetry of the inferior breast implant position. Subsequent revisions of transaxillary-placed breast implants usually require inframammary or periareolar incisions. Transaxillary breast augmentation procedures can be performed with or without an endoscope (video camera). With the transaxillary breast augmentation technique, breast implants are usually placed below the muscle.

The impact to milk production is usually minimal with the transaxillary breast augmentation technique because the glandular tissue and nerves are largely undisturbed. As with the other breast augmentation techniques, placement of the breast implant above the muscle will result in greater impairment than placement of the breast implant underneath the muscle.

During the breast enhancement procedure, the doctor will make the transaxillary incision and create a channel from the armpit to the breast area to place the implant.

Transumbilical Breast Augmentation Technique

The transumbilical procedure requires inflatable breast implants, since it is not possible to have a pre-filled implant guided into the breast area through such a small incision. During the transumbilical technique, the surgeon makes an incision in the belly button area and then creates a "V" shaped passage from the incision to each breast. In very rare cases, this can actually leave "V" shaped tracks on the patient's stomach area. After the passage has been made from the transumbilical incision to each breast, the surgeon will use a small surgical camera called an endoscope to guide the implants into their pocket. Once the implant is in place, a small tube will be guided in to fill the breast implant to its predetermined volume. Lastly, the transumbilical incision will be closed.

The transumbilical breast augmentation technique is less common. It enables breast implants to be placed with no visible scars on the breast but makes appropriate dissection and implant placement more difficult when compared to other breast augmentation techniques.

This breast augmentation technique is not appropriate for placing silicone gel implants because of potential damage of the breast implant shell if attempting insertion through the small incision in the navel, and as those implants are pre-filled they cannot be passed through that navel incision.

The transumbilical breast augmentation technique also permits placement of the breast implant only above the muscle, which preserves glandular function and nerve response. This translates into a minimal impact to milk production.

Transabdominoplasty Breast Augmentation Technique

The transabdominoplasty breast augmentation technique is as a safe, straightforward procedure that is recommended for patients who have completed childbearing, have minimal breast ptosis (drooping), and desire a full abdominoplasty. The use of this breast augmentation technique helps avoid scars on or near the breast, maximizes the use of the abdominoplasty incision, and does not add significant surgery time.

The transabdominoplasty (TABA) breast augmentation technique is a procedure similar to transumbilical breast augmentation technique, where the breast implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty procedure.

Areolar Vertical Approach Breast Augmentation Technique

The areolar vertical breast augmentation technique approach is a very similar to the periareolar breast augmentation technique as the incision is the same.

However, the areolar vertical breast augmentation technique leaves a more extended submuscular pocket for silicone gel breast implants than the periareolar breast augmentation technique, through the transglandular section to the top pectoral fascia. The cavity is then drained after being washed with saline solution before the breast implants are placed.

It is best to discuss your particular physical disposition and desired outcomes with your surgeon, before deciding on technique. This will also impact costs associated with the surgery.