The best incision for breast augmentation depends on your body and the type of implants you choose. If you have small breasts, a periareolar incision may be the best option for you. This incision is made around the areola and extends to the bottom edge of the breast. The scar will be visible but should fade with time. If you have large breasts, an inframammary incision might be best. This incision is made underneath each breast and extends down towards the breastbone. It leaves a permanent scar along the crease where your breasts meet your chest wall, but is usually barely noticeable after healing.
A transaxillary incision can also be used if necessary to place larger implants than would fit through an inframammary incision or if there’s not enough skin to make an inframammary incision in the first place because of sagging or excess skin from weight loss or pregnancy. This incision is made under each armpit then around each nipple before continuing down toward the breastbone as with an inframammary incision.
Read on to learn more about Best Incision For Breast Augmentation, New Breast Reconstruction Techniques and Breast Reconstruction Surgery Cost
Best Incision For Breast Augmentation
Breast augmentation continues to be one of the most popular cosmetic surgery procedures in the United States, with 286,254 procedures performed in 2015. That’s an increase of 35% from the year 2000.
When it comes to breast enhancement, patients often feel confused or overwhelmed when selecting an implant or researching different surgical techniques. The final result of any breast augmentation procedure is determined by a series of choices that the patient (with the counsel of their surgeon) will make.
Here are the five main factors to consider regarding breast augmentation:
Size
Breast implant size is one of the most important characteristics that determine the end result of a breast augmentation procedure. Breast implant size is measured in ccs, typically from 200cc to 600cc. Implant size choices usually come down to a combination of the patient’s anatomy and the degree of naturalness of the desired final result.
Many women want an enhanced appearance without the look of being overly (unnaturally) large. To achieve this result it’s very important for an experienced plastic surgeon to educate the patient on how each implant size will alter their unique physique. One of the best ways to accomplish this is for the patient to try on different implant sizers and see how each size will look. Additionally, patients should ask to view various before and after images of previous augmentation patients with a similar body frame.
Silicone vs saline
The second big decision regarding implants is the choice between saline or silicone implants. Saline implants are filled with sterile saline (salt water) which are filled by the surgeon after placement. This is convenient as it allows your surgeon to set the implants to get the exact desired outcome of the patient. Additionally, the incision necessary for placement is slightly smaller compared to what’s necessary for silicone implants.
Silicone implants are made with a silicone gel that is designed to closely mimic the feel of human fat. Although there is no hard scientific data, silicone is thought to have a more natural appearance and feel. Unlike saline implants, silicone breast implants are placed in the body fully filled. Silicone implants are typically about $1,000 more than saline versions.
More recently, a newer implant option has become available in the United States – the “gummy bear” implant. Gummy bear implants (known medically as form-stable, or cohesive-gel implants) are filled with thicker silicone than traditional silicone implants. They are designed to mimic the natural slope and shape of the breast. The thicker silicone filling, which is similar to that of the popular gummy bear candy, allows the implant to maintain this natural shape. The incisions required for these implants are substantially larger than those required for traditional silicone or saline implants. Additionally, the outcomes can feel more firm than comparable sized smooth round implants.
Surgical incision
There are four unique types of incisions: transaxillary, inframmary, areolar and trans-umbilical breast augmentation (otherwise known as TUBA). Periareolar and inframammary are the two most common incisions and most surgeons are well versed in these two types. In the periareolar incision, the surgeon makes an incision near the lower half of the areola, which in turn hides the scar. This type of incision can have an optimal outcome when combined with the breast lift or mastopexy. These are often preferable in patients with poorly defined inframammary folds or in those prone to hypertrophic scarring (thick raised scars).
When performing an inframammary incision, the surgeon creates an incision in the crease under the breast, allowing the surgeon maximum access when placing the implants. This type of incision is ideal for silicone implants as it better exposes the breast tissue-pectoralis muscle interface. It is the most commonly performed approach in the Unites States and is best suited for patients with well-formed inframmary folds who have a history of favorable scarring.
Both the TUBA and transaxillary incisions are far less common, and they can only be performed when utilizing saline implants. In the transsaxillary incision, the surgeon creates a small incision in the armpit, also dissecting a tunnel to place the implant in. This kind of technique creates no scar on the breast but it does cause more of a likelihood of inferior asymmetry of the implants. In the TUBA incision, the surgeon makes an incision in the naval area, dissecting a tunnel upwards towards the breast area. In these two types of incisions, the empty saline implant is then rolled up much like a cigar and led through the dissected tunnel to be placed within the breast. At that point, the implant is then filled to the pre-determined amount.
Surface
Women can choose between breast implants with a smooth surface or textured surface:
- Smooth implants have a higher chance of moving in the pocket (displacement) compared to textured implants.
- Smooth implants tend to have a slightly lower rupture rate and last longer.
- Textured implants have a thicker shell than smooth implants, generally making textured implants feel firmer.
- Textured implants were designed to minimize capsular contracture (However, studies vary on capsular contracture prevention).
- When the implants are placed in the submuscular space, the rate of capsular contracture tends to be the same with both smooth and textured implants.
Shape
There are two types of shape options for breast implants: round or anatomical.
Round Breast Implants
Round breast implants have a symmetrical round shape. The round shape is beneficial as there is no malformation of breast shape should the implant move within the pocket. Round breast implants come in both textured and smooth surfaces and they tend to be less costly than anatomical implants.
A common misconception about round shaped implants is that they tend to look unnatural once implanted. This is not true: round implants can look just as natural as the anatomical type and vice versa. When a rounded implant is in the vertical position, they take on the same shape as an anatomical implant (which has been proven via radiographic imaging). As always, the final result of your augmentation will depend on factors such as your anatomy, the experience level of your plastic surgeon and the technique used to place the implant.
Anatomical Breast Implants / Contoured Breast Implants
Anatomical breast implants were initially designed for the purpose of breast reconstruction. However, they have begun making their way into the world of cosmetic augmentation. Anatomical breast implants look oval-shaped when viewed from the front. When viewed from the side they appear to have more volume at the bottom, giving the implant a “bottom heavy” appearance since there is more volume at the bottom than the top.
One risk of anatomical shaped implants is that if they shift in position, an asymmetry can occur. To minimize displacement anatomical implants feature a textured surface which allows for tissue adherence; helping to keep the implant in the proper position. If you are considering an anatomical shape it is important to choose a plastic surgeon that has experience in anatomical implant placement as the pocket must be precisely created.
New Breast Reconstruction Techniques
You might be having a mastectomy because you have breast cancer or to prevent the disease if it runs in your family. If so, you may also be considering breast reconstruction to rebuild your breasts, which isn’t a one-size-fits-all procedure. Some techniques use artificial implants, some use your own tissue. Others use a combination of both.
It can be difficult sifting through the choices to figure out what will work best for you. But the most important thing to know is that there are options, says Michele Manahan, M.D., an associate professor of plastic and reconstructive surgery at Johns Hopkins Medicine. “Breast reconstruction is not one-size-fits-all. Now more than ever we have so many ways to restore your form and make you look and feel like yourself again.”
A New, Less Painful Breast Implant Procedure
Manahan and her colleagues perform a state-of-the art procedure called pre-pectoral breast reconstruction. It reduces pain and provides a speedier recovery compared with traditional reconstruction by placing implants or tissue expanders on top of the pectoral muscles. Since the muscles aren’t cut or stretched, you can return to your normal daily activities sooner. “Our patients are doing yoga and have full range of motion within the first month after the procedure,” Manahan says.
The pre-pectoral procedure is the most minimally invasive breast reconstruction option. Your doctor can perform a mastectomy by removing breast tissue through a small incision underneath the breast. Through this incision, a tissue expander can be placed on top of the muscle to create a breast mound. Later, your doctor can remove the expander through the same incision and insert an implant.
A Natural Alternative to Breast Implants
Although using implants lets you recover faster, not everyone likes the way they look or the prospect of needing future surgeries to replace them if they rupture. A natural alternative involves using fat and tissue from another area of your body to fill in your breasts.
In the past, doctors removed muscle, fat and skin from the abdominal wall, the back, the inner thighs or the buttocks and moved it to the chest to form breasts. This procedure was painful and had a long recovery. But now an updated technique lets you use your own tissue with less pain and faster healing. During this surgery, called a perforator flap procedure, your surgeon moves only skin, fat and tissue — not muscle — to your chest area. Not everyone is a candidate for this procedure, depending on anatomy and previous surgical history, but it’s a good option for some women.
Using your own tissue creates a more natural look. And you can also have a tummy tuck, thigh lift or buttock lift at the same time if you have tissue removed from those areas.
Traditional Breast Reconstruction
The majority of breast reconstruction procedures involve breast implants. In this traditional reconstruction procedure, saline or silicone implants are placed below the pectoral muscles, forcing them to stretch to accommodate the implants. “This method works for a good deal of people, but many women experience pain as well as decreased range of motion in the shoulder,” reports Manahan. “Over time, chest wall deformities from the implants can form as well.”
What to Consider Before Breast Reconstruction
There are several things you need to consider when reviewing reconstructive breast cancer options, says Manahan. What procedure is best for you depends on many factors, such as:
- Overall health
- Activity level
- What you do for a living
- Whether you want to have children after surgery
- If you have the extra tissue needed for a natural reconstruction
- How much post-surgery downtime you’re comfortable with
If you’re going to have a lumpectomy or mastectomy, consult with a plastic surgeon in addition to your breast surgeon. A plastic surgeon can provide guidance on the various breast reconstruction procedures and work in partnership with your breast surgeon to give you the look you want.
It’s okay to take your time to come to a decision, says Manahan. “You might not know if you want implants, or whether you want to use belly or thigh tissue, or if you’re going to need radiation. But you can still move forward with the mastectomy. We can insert a tissue expander to hold a breast-like form under your skin. Then, when you’re ready, we can remove the expander and reconstruct your breasts with either implants or your own tissue. What’s important is knowing there are many options for breast reconstruction, and consulting with your surgeon to find the best choice for you.”
Everyone and every body is different, reminds Manahan, and every patient has different preferences and goals. “We hope that the many choices we have to offer for breast reconstruction will allow us to tailor each reconstruction to each individual patient.”
Breast Reconstruction Surgery Cost
Breast reconstruction comes in a wide variety of forms and the cost in the private sector is dependent on the stages of surgery, and type of reconstruction. Different types of breast reconstruction have different complexity and therefore different amount of time and effort required by the surgeon for your surgery.
It also depends on whether it is performed at the same time as the mastectomy or in a delayed fashion, and may also include costs for an anaesthetist, surgical assistant, hospital excess, and other fees. Usually, in the private sector, all fees are quoted inclusive of follow up both in hospital and in rooms after the surgery.
What is the cost of breast reconstruction in a public hospital?
In Australia, it is possible to have all forms of breast reconstruction in a public hospital free of charge, covered entirely by Medicare. Read what it means to be a public patient section of our website for more information. The main limitations of this option are:
– Possible increased wait time
– Less say of when and where your surgery will be performed with limited flexibility
– Registrars or fellows may be doing all or part of the procedure
– Follow up is generally in public hospital clinics, and wait associated with these
– Your date of surgery or supervising surgeon may be changed
Why is there is an out of pocket cost for breast reconstruction in a private hospital?
Despite having ‘top’ level of cover many patients ask why there is an out of pocket for procedures done in the private sector. This also applies to breast reconstruction. This is because the reimbursement or what Medicare and Health Funds pay is dependent on the schedule fee as listed for each Medicare item number. Unfortunately, the government has frozen this for decades meaning the reimbursement for each procedure is way behind what the actual cost of the procedure.
The Australian Medical Association each year publishes what it considers the fair value to be charged for each procedure and this is what many surgeons, including plastic surgeons, use to guide their fee structure. This means there is usually a ‘gap’ between the AMA fee and the Medicare schedule fee, and this constitutes the out of pocket cost. This often applies to both surgeon’s fees and anaesthetist’s fees.
While the main disadvantage of private treatment is an out of pocket cost, there are many advantages of private treatment:
– Total flexibility over time: often surgeons work with the patient’s time commitments and availability as to when to schedule the surgery
– Complete say over where your surgery will be performed
– Complete choice over surgeon and the main consultant surgeon performing your surgery
– Follow up is in private rooms with direct contact with the main surgeon who makes all the decisions
– Your date of surgery is usually fixed and won’t be changed (Unless negotiated with you)
What are the aims of breast reconstruction?
The aim of breast reconstruction is to:
– Create a breast mound
– Look great in clothes (even tight-fitting dresses)
– Achieve symmetry with the opposite breast (in cases of one-sided or unilateral reconstruction)
– Avoid the use of a prosthesis
What types of breast reconstruction are there?
There are 3 main categories:
- Implant or expander based breast reconstruction (i.e. using foreign tissue)
- Autologous breast reconstruction (using your own tissue only)
- Combination of autologous and implant or expander reconstruction – usually reserved for patients who have required radiation in their cancer treatment and do not have enough own tissue to make an entire breast
In general breast reconstruction is always a staged operation. This is often the case with implant reconstruction, which is often performed in 2 stages. Own tissue reconstruction is usually performed in a single stage but there may be a second stage for nipple reconstruction.