Featured Experts Dr. Ari Hoschander, a board-certified plastic surgeon in Rockville Centre, New York Dr. Elie Levine, a board-certified plastic surgeon in New York City Dr. Sanjay Grover, a board-certified plastic surgeon in Newport, California
When it comes to the decisions related to breast augmentation, it’s not merely the type of implant and its positioning that need consideration. The entry point – where the plastic surgeon makes an incision for inserting the implant – is equally significant and determines the sort of scar you might have. Generally, breast augmentation scars are far less conspicuous than those from, say, a tummy tuck. Yet, they are still scars. With the increasing searches for “scarless breast augmentations”, we consulted top doctors to determine if there’s actually any way to conduct this surgery without leaving scars. Here’s what they stated.
Is it feasible to have a scarless breast augmentation?
“A scarless breast augmentation is absolutely not possible,” remarks Dr. Ari Hoschander, a board-certified plastic surgeon in Rockville Centre, New York. “You can have a concealed scar or an imperceptible scar, but a scarless augmentation simply doesn’t exist.”
Dr. Elie Levine, a board-certified plastic surgeon in New York City, indicates that fat transfer to the breasts is sometimes referred to as a scarless breast augmentation – but if an implant is involved, there’s no way for the procedure to be scar-free, he asserts. Nevertheless, depending on the method of entry, it’s possible to end up with scars that are nearly undetectable. Below, the appearance of breast augmentation scars based on four distinct entry points, along with the advantages and disadvantages of each.
Inframammary fold
The most conventional and prevalent place for making an incision is in the crease beneath the breast – the inframammary fold (IMF). Dr. Hoschander says this is the approach he employs for 95% to 98% of the breast augmentations he undertakes.
Why is it so favored? It works effectively for silicone or saline implants, has lower rates of capsular contraction (more on this shortly), and enables the surgeon to achieve the optimal positioning of the implant, he notes. The scar is approximately three and a half to four centimeters in length and is typically well concealed under the breast, he adds.
Dr. Sanjay Grover, a board-certified plastic surgeon in Newport, California, also predominantly uses this technique; he mentions that he likes that it allows him to utilize cohesive, “gummy bear” implants, which can’t be inserted through the other methods.
Nevertheless, there are specific cases where an IMF incision might not be the ideal choice. For women who don’t have a clearly defined breast shape with a prominent breast fold, there’s no place to position or hide the scar, notes Dr. Levine. Similarly, an IMF incision is impossible for women undergoing an augmentation to correct tuberous breasts, as they lack this fold entirely, Dr. Hoschander adds.
Periareolar
A periareolar incision is one alternative. The incision is made in a half-circle around the bottom of the areola, from the three o’clock to the nine o’clock position, Dr. Hoschander explains. The benefits? “The scar is truly camouflaged very well here, because there’s already a lot of irregularity around the border of the areola,” points out Dr. Levine. The drawback? Especially if you’re using a very large implant, there’s an elevated risk of nipple sensation loss with a periareolar approach, he says. Capsular contracture rates are also generally higher, due to increased bacteria in the area, says Dr. Hoschander.
Transaxillary
For those who don’t desire any type of scars on their breasts, a transaxillary approach – making an incision in the armpit – is a common alternative. “When I refer to ‘scarless’, I mean I’m performing a breast augmentation without a scar on the breast. I create it inside a crease in the armpit, where it’s nearly imperceptible,” says Dr. Grover. This technique was highly popular in the early 2000s, when saline implants were the preferred choice, he says. (Because they fold flat, like a deflated balloon, they can be inserted via small incisions further from the breast, pushed into position, and then filled.)
However, thanks to a tool known as a Keller funnel, it’s now feasible to insert silicone implants via the armpit as well, Dr. Grover says, adding that the scar is typically about two inches long. He also relies on the use of an endoscope to enable proper dissection and implant positioning, though he notes that he is one of the few surgeons to do so. In addition to for those who wish to keep their breasts completely scar-free, Dr. Grover says, the transaxillary technique is a very popular option among patients transitioning from male to female; not only is the chest too flat for an IMF incision, but a breast without incisions appears more natural, he says.
Just bear in mind that the increased quantity of bacteria in this area is associated with a higher risk of capsular contracture. The use of the funnel does reduce this, but if it occurs, you can’t perform a capsulectomy through the same incision and will need one in the IMF anyway, Dr. Grover explains.
Transumbilical
Placing an implant through a semicircular incision made around the top of the belly button is another option, although it’s not particularly common or effective, as noted by the doctors we conversed with. Since it can only be done with saline implants (again, because they aren’t prefilled), Dr. Levine notes that it was much more popular when saline was in vogue. He also adds that it’s best reserved for smaller implants and those with a long torso or a prominent rib cage aren’t suitable candidates. And while your breasts will be scar-free, the simple fact that the belly button is so distant from the breasts makes it extremely challenging to achieve a good aesthetic outcome, notes Dr. Hoschander. Dr. Grover also isn’t a supporter, adding that surgeons are essentially dissecting and creating a pocket for the implant completely blindly.
Ultimately, the entry point is definitely something to discuss with your doctor – and keep in mind that it may or may not influence the final cost. Dr. Levine says it doesn’t in his practice; Dr. Grover says that he charges more when he adopts a transaxillary approach. Regardless, all the doctors emphasize the significance of proper scar care after your augmentation – namely, the use of silicone gel or scar sheets for three to six months after the surgery. And remember, just as your breasts will continue to change post-procedure, so will your scars – for up to one or even two years after the surgery, according to Dr. Hoschander.
