Q: Dr. Eppley, It was good to meet you today to discuss my wife’s breast augmentation incisions options. We had a follow-up question for Dr. Eppley regarding one aspect of the proposed augmentation that we were hoping he could comment on.
We visited with another plastic surgeon later today,who suggested that because of her ever-so-slightly nipples facing outward and to the sides and not completely to the front, he would most likely insert the implants somewhat to the outside edge of her breasts so as to promote a more inward-facing profile of her breasts post-surgery. In effect, the surgeon expressed an interest in being able to have the greatest amount of control possible in the placement of the implant during surgery. To achieve this greater control, however, the surgeon advocated for inserting the implants through the areola instead of through the armpit.
While she definitely likes the idea of a transaxillary implant so as to avoid the presence of scars on her breasts, we would like to understand whether in fact it’s true that this approach might not give as much control around the implant placement, especially given her particular physical circumstances. Could you give us some perspective on this issue and whether indeed there’s a tradeoff here between the two insertion approaches that we should more carefully consider?
A: It is important to understand that the location of the incision in breast augmentation is largely about access to the submuscular and subfascial breast planes..once you are in there what is done is the same…the development of the implant pocket. Considerable experience and skill allows a plastic surgeon to use any of the incisions will equal ability to make whatever pocket one wants. Plastic surgeons frequently use only one incisional approach because that is what they are most comfortable doing so it eventually becomes the ‘best’ way to do the operation…and if that is what their comfort zone is then it is in fact the best way for them to do it. But the areolar incisional approach offers no advantages in terms of visibility or pocket creation than either the transaxillary or inframammary approach breast augmentation incisions.
One of the keys to breast implant placement is to get it centered on the existing breast mound. Trying to place it more to the side so the nipple might be ‘pushed inward’ is not going to create that effect and tuns the risk of having an implant becoming lateralized or ending up too far to the side of the chest wall. This is one implant location to avoid as it is a difficult problem to fix later. It is far better to accept some minor nipple location flaws than to create what may turn out to be a bigger aesthetic problem later.
Dr. Barry Eppley