Introduction
Breast augmentation is a highly sought - after cosmetic surgical procedure that aims to enhance the size, shape, and symmetry of the breasts. In New York City, one of the fashion and beauty capitals of the world, the demand for breast augmentation is consistently high. A crucial aspect of this procedure is the choice of incision, which can significantly impact the outcome, scar appearance, and overall patient experience. In this article, we will delve into the top ten incisions for breast augmentation surgery in New York City, exploring their characteristics, advantages, disadvantages, and the factors that influence their popularity.
1. Inframammary Incision
Description
The inframammary incision is made in the crease under the breast, where the breast meets the torso. It is one of the most commonly used incisions for breast augmentation. According to research from "Best Incision and Placement Options for Breast Augmentation NYC | Steven Wallach MD, FACS," this incision provides direct access to the breast tissue and the breast pocket.
Advantages
- Excellent visualization: Surgeons can clearly see the breast pocket and any bleeding points, allowing for more precise implant placement. This results in better - fitting implants and potentially fewer complications.
- Versatility: It can be used for both saline and silicone gel implants. Whether a patient desires a natural - looking or more prominent result, this incision can accommodate different types of implants.
- Scar concealment: The natural breast crease helps to hide the scar. Over time, the scar typically fades and becomes less noticeable, especially when the patient is wearing a bra or swimwear.
Disadvantages
- Visible scar in some cases: If the patient gains or loses a significant amount of weight, or if the scar does not heal properly, it may become more visible. Additionally, some women may require tattooing to further camouflage the scar.
- “Double bubble” risk: There is a slightly higher tendency for the inframammary fold to be undermined, which can lead to a “double bubble” deformity, where the implant appears to sit on top of part of the breast tissue.
2. Periareolar Incision
Description
The periareolar incision is made around the border of the areola, the darker - colored skin surrounding the nipple. As described in "Best Breast Augmentation NYC | Dr. John E. Sherman," this incision takes advantage of the natural color change in the area to hide the scar.
Advantages
- Scar blending: When the scar heals well, it can blend in with the color of the areola, making it less visible. This is particularly beneficial for patients who are concerned about scar appearance.
- Good visualization for some procedures: It allows the surgeon to have a clear view of the breast pocket in many cases, and can also be useful for addressing certain breast deformities or asymmetries during the augmentation process.
Disadvantages
- Noticeable scar: In some patients, especially those with fair skin or poor wound - healing, the scar may be more noticeable. It may require scar care treatments to improve its appearance.
- Size limitations: If the areola is too small, it may not be large enough to allow for the placement of certain types of implants, especially silicone breast implants. Saline implants can be placed through a smaller areola, but this may still be a limiting factor for some patients.
- Higher risk of capsular contracture: Recent studies have suggested that the periareolar approach may be associated with a higher rate of capsular contracture compared to the inframammary incision. Capsular contracture is the formation of scar tissue around the implant, which can cause the breast to feel firm and may distort its shape.
3. Axillary Incision
Description
The axillary incision, also known as the transaxillary incision, is made in the armpit. Surgeons create a pathway from the armpit to the breast tissue to place the implant without leaving a visible scar on the breast itself. According to "Where were the most popular locations for Breast Augmentation Incisions in 2024? - Plastic Surgeon Manhattan | Cosmetic Plastic Surgery New York," this approach is less commonly used but still an option for some patients.
Advantages
- No breast scar: The main advantage is that there is no visible scar on the breast, which can be appealing to patients who are concerned about scarring on the chest area.
Disadvantages
- Visible scar when arm is raised: The scar in the armpit can be visible when the patient raises their arm. In some cases, tattooing may be necessary to camouflage the scar.
- Implant positioning issues: It can be more challenging to achieve accurate implant positioning, especially without the use of endoscopic visualization. This can increase the risk of the implant being misaligned or in an undesirable position.
- Bleeding control difficulties: It can be difficult to gain control of potential bleeding sources from this remote access, which may increase the complexity of the surgery and the risk of complications.
- Silicone implant placement challenges: Placing silicone breast implants through this incision can be very difficult due to the shape and size of the implants and the narrow access path.
4. Transabdominal Breast Augmentation (TABA)
Description
Transabdominal breast augmentation involves making an incision in the upper abdomen, often in conjunction with an abdominoplasty (tummy tuck). As mentioned in "Best Incision and Placement Options for Breast Augmentation NYC | Steven Wallach MD, FACS," this is a rare approach.
Advantages
- No breast incisions: There are no incisions on or near the breast, which can be a significant advantage for patients who want to avoid visible scarring on the chest.
- Good visualization: There is usually good visualization of the breast pocket and bleeding points, as an adequately sized tunnel from the upper abdomen to the chest is created.
- Implant placement options: Both saline and silicone breast implants can be placed through this incision.
Disadvantages
- Patient eligibility: This procedure is only suitable for women without significant breast ptosis (drooping) and who also desire a full tummy tuck. It is not a viable option for all breast augmentation patients.
5. Transumbilical Breast Augmentation (TUBA)
Description
Transumbilical breast augmentation uses an incision in the belly button. This approach was more common in the past but is not often performed anymore. According to "Best Incision and Placement Options for Breast Augmentation NYC | Steven Wallach MD, FACS," it offers a unique way to place breast implants without incisions on the breast.
Advantages
- No breast incisions: Similar to TABA, there are no incisions on or near the breast, resulting in a breast - scar - free appearance.
Disadvantages
- Poor visualization: It is difficult for the plastic surgeon to visualize the breast implant pocket, which can make accurate implant placement more challenging.
- Bleeding management: In case of bleeding, an additional inframammary or periareolar incision may be required to gain access for treatment.
- Implant limitations: Only saline implants can be placed through this incision, which restricts the options for patients who prefer silicone implants.
6. Modified Inframammary Incision
Description
Some surgeons in New York City may use a modified inframammary incision. For example, in "Breast Augmentation Incisions: Which One is the Best? - Dr. Hess," a surgeon makes the incision 1 cm or about 1/2 inch below the normal inframammary fold. After the implant is placed and the skin is pulled up, the incision ends up exactly in the fold, providing better scar camouflage.
Advantages
- Enhanced scar concealment: By placing the incision in a more strategic location, the scar is better hidden in the breast crease, reducing its visibility.
- Direct muscle access: It still allows for direct access to the muscle without injuring the breast tissue, similar to the traditional inframammary incision.
Disadvantages
- Technical skill required: This modified approach may require more technical skill from the surgeon to ensure proper placement and to achieve the desired result.
7. Extended Periareolar Incision
Description
An extended periareolar incision is a variation of the traditional periareolar incision. It may be used in cases where more access to the breast tissue is needed, such as when addressing complex breast deformities or placing larger implants. Although not as commonly discussed, it is an option that some surgeons may consider.
Advantages
- Improved access: Allows for better access to the breast tissue compared to the standard periareolar incision, which can be beneficial for certain procedures.
Disadvantages
- Increased scarring: Since it is an extended incision, there is a greater potential for more visible scarring, even though it is still around the areola. This may require more intensive scar - care treatments.
- Higher risk of complications: With the extended access, there may be a slightly higher risk of complications such as infection or capsular contracture.
8. Dual Incision Approach
Description
A dual incision approach may involve using two different incisions during the breast augmentation procedure. For example, a surgeon might use an inframammary incision for initial access and a periareolar incision for additional adjustments or to address specific issues within the breast. This approach is highly individualized and depends on the patient's unique anatomy and surgical goals.
Advantages
- Customization: It allows for greater customization of the surgical procedure, enabling the surgeon to take advantage of the benefits of multiple incisions and address different aspects of the breast augmentation more effectively.
Disadvantages
- Multiple scars: There will be multiple scars, which may increase the overall scarring and the complexity of scar management. The patient may also be more at risk of complications associated with each individual incision.
- Increased surgical time: Using two incisions may increase the length of the surgery, which can lead to more stress on the patient's body and a longer recovery period.
9. Endoscopic - Assisted Axillary Incision
Description
The endoscopic - assisted axillary incision combines the axillary approach with the use of an endoscope, a thin tube with a light and a camera. This allows the surgeon to have better visualization of the breast tissue and the implant pocket while making the incision in the armpit. As mentioned in some sources, this technique can improve the accuracy of implant placement in the axillary approach.
Advantages
- Improved visualization: The endoscope provides a clear view of the surgical area, reducing the risk of implant misplacement and other complications.
- Minimal scarring on breast: It still maintains the advantage of having no visible scar on the breast.
Disadvantages
- Specialized equipment and skill: This technique requires specialized endoscopic equipment and a surgeon with expertise in using it. Not all surgeons may be trained in this method.
- Cost: The use of endoscopic equipment may increase the cost of the surgery.
10. Keller Funnel - Assisted Incisions
Description
The Keller Funnel is an implant delivery device that can be used with various incisions, such as the inframammary or periareolar incisions. According to "Breast Augmentation - Incision Locations - Dr. Naidu," it has an interior hydrophilic coating that creates a slick surface and a low - friction interface. The implant gently passes through the funnel and into the breast pocket, limiting trauma to both the patient's tissues and the implant.
Advantages
- Reduced trauma: It helps to reduce the amount of contact between the surgeon's hands and the implant, minimizing the risk of contamination and trauma to the implant and surrounding tissues.
- Easier implant placement: Facilitates the placement of the implant through a smaller incision, which can result in less scarring and a quicker recovery.
Disadvantages
- Cost: The use of the Keller Funnel may add to the overall cost of the surgery.
- Availability: It may not be available at all surgical facilities, which could limit its use for some patients.
Factors Influencing Incision Choice in New York City
Patient Preferences
Patient preferences play a significant role in the choice of incision. Some patients are extremely concerned about scarring and may prefer incisions that are well - hidden, such as the axillary or transumbilical incisions. Others may prioritize the natural look and feel of the breasts and may opt for incisions that allow for better implant placement and less risk of complications, like the inframammary incision.
Surgeon's Expertise
The experience and expertise of the surgeon are crucial. Surgeons in New York City may have different levels of proficiency in various incisions. For example, some surgeons may be more skilled in performing endoscopic - assisted axillary incisions, while others may be experts in the modified inframammary approach. Patients often choose a surgeon based on their reputation and the types of incisions they are comfortable with.
Implant Type
The type of implant a patient chooses can also influence the incision choice. Saline implants can be placed through smaller incisions compared to silicone implants. Some incisions, such as the transumbilical incision, are only suitable for saline implants. Additionally, the shape and size of the implant may require a particular incision to ensure proper placement.
Breast Anatomy
The patient's breast anatomy, including the size of the areola, the amount of breast tissue, and the presence of breast ptosis, is an important consideration. For example, patients with small areolas may not be suitable candidates for periareolar incisions, while those with significant ptosis may require a different approach to achieve the desired result.
Conclusion
Choosing the right incision for breast augmentation surgery in New York City is a complex decision that involves multiple factors. Each of the top ten incisions we've discussed has its own set of advantages and disadvantages. The inframammary incision remains a popular choice due to its versatility and good visualization, while the axillary incision offers a scar - free option on the breast. Other incisions, such as the TABA, TUBA, and various modified incisions, provide specialized solutions for specific patient needs.
When considering breast augmentation, it is essential for patients to have in - depth consultations with board - certified plastic surgeons in New York City. These surgeons can evaluate the patient's unique circumstances, discuss the different incision options, and help the patient make an informed decision that will lead to the best possible outcome. Whether you're looking to enhance your confidence or achieve a more proportionate figure, understanding the incision options is the first step towards a successful breast augmentation.
If you're interested in learning more about breast augmentation surgery in New York City or want to schedule a consultation, reach out to a qualified plastic surgeon today. Share this article with friends who may be considering the same procedure to help them make an informed choice.
