Breast Augmentation Frequently Asked Questions
Breast Implant Incision Questions
Incision Locations—Which is best for me?
Inframammary Incision
An inframmamary incision is made under the breast, within the fold or crease. It is the most commonly used approach for breast implant placement. Many surgeons prefer this incision because it gives them the most control over the placement of the breast implant. The disadvantage is that there is a visible scar on the breast and the incision may take longer to heal.
Periareolar Incision
A periareolar incision is made around part of the areola, the darker skin surrounding the nipple, not the nipple itself. Generally, the incision is made around the lower half of the areola. The scar tends to heal well and the change in color from the areola to the breast skin tends to hide the scar. The disadvantages are that this site may interfere with a woman's ability to breast-feed and there is a higher risk of losing sensation in the nipple. A periareolar incision gives the doctor excellent control over the placement of the breast implant.
Axillary or Transaxillary Incision
A transaxillary incision is made in the armpit and a tunnel is made over to and under the breast through which the breast implant is placed. A camera is often inserted into the breast pocket so the surgeon can see the pocket directly. The primary benefit is that there is no scar on the breast. Once the scar in the armpit has healed, it is generally very hard to see. Additionally, there is little risk of losing sensation to the nipple.
TUBA (TransUmbilical Breast Augmentation) Incision
A transumbilical incision is made in the navel or belly button. An endoscope or tube is inserted through the navel up to the breast through which the breast implant is placed. A camera is often used so the surgeon can see the breast pocket while she is operating. The primary benefit is that there is no visible scar. The scar is buried in the navel. The major disadvantage is that achieving symmetry of the breasts can be more difficult. Relatively few plastic surgeons are trained in this technique.
How long will my incision be?
The length of the incision can depend on a number of factors, including placement and breast implant type, surface, and size. Generally, incisions run from 1 to 1½ inches, but in rare circumstances can be as long as 4 inches. The incisions for saline breast implants are smaller because the breast implant can be rolled up like a soft taco when it is inserted. A textured breast implant is slightly thicker and requires a slighter larger incision. Prefilled breast implants, like silicone gel breast implants, cannot be rolled up tightly, so they require a larger incision to fit the breast implant through. Of course, a larger breast implant will require a larger opening than a smaller one. A saline breast implant can be placed through a 1 inch incision; a large silicone breast implant will require at least a 1½ inch incision.
How do I know if there's a problem with my incision?
If your incision is slow to heal, is red, has red lines emanating from it, feels warm, appears to be opening up, or has pus oozing from it, you need to contact the doctor immediately. These could be symptoms of infection. For these reasons, among others, it is very important that you keep your postoperative appointments with the doctor so that she can see how the wound is healing and take any corrective actions if necessary. The overwhelming majority of breast augmentation patients have no serious problems with their wounds healing.
My incision itches. What can I do about it?
Itching is often a sign that the wound is healing. It's normal and not usually a cause for concern. Applying a warm or cool compress to the skin around the incision can help alleviate the itchiness. Do not apply topical ointments or creams to the wound unless the wound is completely healed. Once the wound has healed completely, the itching should resolve.
How can I care for the incision after the surgery, so that it heals as nicely as possible?
After the wound has closed, Dr. Pittman–Waller recommends using Mederma or Scarguard to help minimize scars. Applying one or the other to the wound twice daily for a couple of weeks appears to improve the final appearance of scars.
If I am getting a lift, can my lift incisions be used to insert my breast implants?
Yes. If you are having a breast lift and a breast augmentation, the breast implants will be inserted through the same incision used for the lift. If you are having a tummy tuck and a breast augmentation, the tummy tuck incision can sometimes, but not always, be used for the breast augmentation as well. Ask the doctor whether this is possible in your case.
My bra is hurting my incision lines, what can I do?
Dr. Pittman–Waller recommends placing padding between the bra and the incisions. You may use something as simple as gauze, or a panty shield, or a protective pad. Epi-foam by Biodermis Corp. is a polyurethane foam pad which helps ensure consistent compression distribution and can be used as a protective barrier, if desired.
How long does it take for scars to fade? Do some areas heal better than others?
The rate of scar healing varies. Some people heal faster than others. Surgical wounds should be healed within 4 to 6 weeks. The scars, however, will take 12 to 18 months to completely mature. Along the way, it will look its worst at about 3 months when it is raised and red, in light skinned people, or pigmented, in dark skinned people. Afterwards, the scar will begin to fade to a color closer to your natural skin color.
Will my surgeon use permanent, non–dissolvable, or dissolvable sutures for my incision lines?
Dr. Pittman–Waller generally uses dissolvable sutures that will completely resorb in several months. Usually, there won't be any need to remove the sutures after the breast augmentation surgery.
What are Steri-StripsTM or Surgi-Tape?
Steri-StripTM Skin Closure is a product made by 3M whereas surgi-tape is a generic term for adhesive medical paper tapes. Steri-Strips help align the skin edges to get the best scar formation possible. Dr. Pittman–Waller uses them with all breast augmentation incisions.
Can't my surgeon use tissue glue on my incisions?
Fibrin and other tissue glues are often used in face lifts and abdominoplasties where there is a need for adherence and there may be long incisions. Dr. Pittman–Waller uses tissue glue in abdominoplasties, but only rarely in breast augmentation, which have very short incisions. She believes she can get as good a closure with the Steri-Strips as with tissue glue, without the added cost for the patient.
How long do I have to wait to use scar remedies on my incision lines?
You must wait until the incision has closed, generally about one week. You want to be sure not to use an unsterile product on a wound before it has healed.
I want to go larger or need a revision. Can my surgeon use my old incisions?
Yes, usually, unless it's the axillary or TUBA incision. There is no need to have additional incisions if you are only having removal or replacement with no lift and had inframammary or periareolar incisions. It's not possible to re-tunnel from the armpit with an axillary incision or from the navel with a TUBA incision because of the scar tissue that has formed.
If I start to develop hypertrophic scarring what can be done about it?
Silicone Sheeting has been shown to significantly help prevent and lessen the appearance of keloidal and hypertrophic scarring. Epi-derm by Biodermis is a silicone gel sheeting which has been shown to be an effective method of scar treatment. Rejuveness silicone sheeting is another effective treatment.
More Breast Enlargement FAQs
- Understanding Breast Implants
- Breast Implant Placement Questions
- Health & Pregnancy Questions
- Breast Implant Surgery Questions
- After Breast Enlargement Surgery Questions
- When Can I... Questions
Breast Cosmetic Surgery Information
- Read an excerpt from Dr. Pittman–Waller's book The New Breast Book: New Breasts for a New Look and a New Outlook
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Breast Augmentation – Breast Lift (Mastopexy) – Breast Reduction