NEW AND EXCITING CHANGES IN BREAST AUGMENTATION INCISIONS

NEW AND EXCITING CHANGES IN BREAST AUGMENTATION INCISIONS
JAMES ROMANO MD

INTRO
There has been an explosion recently in the very new science in choosing a breast implant surgery incision. This comes from directly all of our new information about biofilm and its direct relationship to infection, but mostly, the most feared side effect of breast augmentation surgery: capsular contracture.

BACKGROUND
When it comes to having a breast augmentation there are many things to consider. Among these, of course, the location, length and placement of the incision is critically important to virtually all patients.

The considerations for choice of an incision are:
1. Cosmetic
2. The degree of importance of sensation to the patient
3. Anatomy of the breast and needs of surgery for exposure and dissection and control
4. Size and type of implant
5. Skin color, areolar size
6. Primary or revision procedure
7. Location of previous incisions

The Four Types of Implant Incisions are:
1. Inframammary Incision
2. Periareolar Incision
3. Transaxillary Incision
4. Transumbilicial/TUBA incision

Inframammary (crease/fold) Incision
The inframammary incision is created through a small, 1.5-2-inch, incision where the breast tissue meets the abdominal skin, known as the breast crease. The surgeon creates the space and the implant is inserted. Think of this incision for the greater part goes UNDER the breast tissue. The difficulty of this incision is in planning ahead if the breast crease will remain in this position or, as is more often, being able to predict where to lower and place this incision to correspond to where the new crease will be lowered to accommodate the larger base diameter created by a breast implant. If this incision is not planned perfectly it will often ride up on the underside of the new breast, where incidentally, it becomes subject to the greatest force of the weight of a breast implant and then always widens and stretches and becomes hypertrophic. The pencil thin incisions must be exactly in the breast crease.

Periareolar (nipple) Incision
The periareolar incision is a semicircular incision made around the edge of the areola, where the darker brown or pink colored area meets the lighter skin. Creating an incision around the areola results in imperceptible scars which are hidden within the natural transition from the dark to light skin. This incision takes advantage of the most central location in the breast for excellent visibility and approach to all the breast anatomy. There must be a distinct border in the color of the areola to the breast skin or the incision will not hide well as in patients with a dark fuzzy border or a very light color pink areola. Think of this incision as one that goes THROUGH the breast tissue. Another big advantage of this incision is that you do not have to predict and plan the location like you would with the inframammary incision.

Transaxillary (armpit) Incision
The transaxillary incision is created high up in the natural concavity of the armpit. A tunnel is made from the armpit to the below the breast. This space is made either with blunt dissection (pushing and ripping tissues) or with the use of an endoscope camera and TV monitor for guidance. The visualization respectively is either non-existent or poor at best. This does not allow the surgeon for ultimate control of the space and operation. For this and other reasons Dr. Romano does not use this incision and approach.

Transumbilical Breast Augmentation (TUBA bell button) Incision
The TUBA incision is created by making an incision half the way around the top of the rim of the navel. Then there is a tunnel created by a big blunt tube underneath the abdominal skin and up to the underside of the breast near the crease. Here, with no visualization at all, a space is made by inflating a collapsed breast implant passed through the tube. The hope (and prayers) here is that the inflated expander creates the correct space of the correct size and does not rupture any blood vessels and looks natural. This is a completely blind surgery where you cannot see anything directly, making it unpredictable. Therefore, Dr. Romano does not perform this procedure.

DISCUSSION
There are four basic breast augmentation incisions and only two that are safe, reasonable, and predictable.

Research has suggested…….
• Going under breast tissue
• Not violating breast glands and ducts where bacteria resides
• Using a Keller funnel
• Lesser bacterial spread and potential contracture

CONCLUSIONS
• Two time honored and very good incisions for placement of breast implants
• Research suggesting less contracture with IM incision