Hello, my name’s Adrian Richards and today I’m going to be talking about the different types of incisions used for breast augmentation surgery. You may have read about this but essentially there are four places an implant can be inserted by.  Number one, through the tummy button, number two is through the crease underneath the breast, number three is underneath the nipple and number four is the armpit.  So first of all, let’s work up from the bottom and then talk about the pros and cons of each.

Through the tummy button is only really used for saline implants which can be completely collapsed and inserted through a very small incision so whereas this type of insertion site seems very attractive, you can only use saline which are salty water filled implants which have problems, potentially more rippling and deflation.  So in England, we tend not to use that approach, I’m not aware of any surgeons in England who use the tummy button approach, principally because it’s very difficult to accurately place the implant.

The second incision, which is probably the most common in England, is an incision in the fold underneath the breast and this is most commonly used because the surgeon can accurately place where the implant is going to go and can actually raise or lower the fold underneath the breast.  So in many people, you need to lower the fold slightly beneath the breast to give a nice gentle curve to the lower part of the breast.  This incision is typically five centimetres long, located slightly offset of the midline in the fold and when it heals, it’s very difficult to see because it’s hidden in the natural contour.

The third type of incision is around the areola and the areola is the brown area around the nipple and typically, this incision is on the junction of the areola and breast skin.  Now quite an attractive approach, not good for people with small areolas because you need a five centimetre incision to get the implant in without damaging it so if you’ve got a small areola it’s perhaps not suitable.  There is also a slightly higher risk of infection because of the secretions from the nipple and also altered sensation to the nipple which puts many people off. 

The fourth approach is through the armpit or the axillary approach. This has some advantages, it’s slightly more difficult to get the implant in exactly the right position and because of the location of the incision, these implants through the armpit are normally put under the muscle, so totally under the muscle. The problem with this approach is slightly higher risk of infection because of going through the armpit.  You can get altered sensation down the inner aspect of the arm because there’s some very important nerves travelling from the chest to the arm which go through that area and probably the biggest downside of that particular incision is it’s difficult for the surgeon to accurately get the implants at exactly the same height because it’s quite a way down to the pocket created.

So just to summarise; four types of incisions, tummy button incision is not really used in England, armpit incision is probably used in about 10% of cases in people who like the idea of a implant under the muscle and the main incisions used in England would be the areola incision, probably used in about 20 to 30% of cases then the vast majority of patients have implants inserted via the fold, in an incision concealed in the fold, probably 60 to 70% of patients in the UK have their implants inserted in that way. 

The important thing is really to talk your surgeon, really have a think about which way you’d like it inserted, which sort of scar is best for you, look at some pictures of patients who’ve had both approaches which the surgeon would be able to give you and have a frank and open discussion with the surgeon about the options.  Thank you.