Breast augmentation can be done using different techniques. Your surgeon should make a decision with you about which method is the most appropriate for you. Be aware of the ways in which breast implants can be placed into the chest and be empowered to make the best choice for you.
1. Types of Incision
The most commonly performed cosmetic surgery procedure is breast augmentation. For this, the type of incision used varies by surgeon so it is important to be aware of the different options.
This is an incision in the lower crease of the breast. There are many advantages to this. It is well-hidden, provides a good view of the operation for the surgeon and has a low complication rate. This type of incision needs to be well-planned and carefully placed. The breast implant pushes the fold downwards when it is put in. Because of this, if the incision is too high then it will appear on the breast itself.
The areola is the dark part of the breast around the nipple. For this technique, the edge of the areola is cut. If the difference between the colour of the areola and the rest of the breast is clear enough, the healed scar will be very difficult to see. This incision is ideal when a breast lift is also being performed and provides good exposure of the underlying tissues. However, there is a slightly increased risk of infection due to being close to the nipple. Any discharge from the nipple or ducts beneath the nipple that have been cut can introduce bacteria.
The axilla is the armpit. A small incision can be made here and a camera is used to help dissect the tissues. The main advantage is that there is no scar on the breast itself. There are a few important problems with this technique. FIrstly, the armpit is a ‘dirty’ area of the body that collects sweat and bacteria. The wound can become infected and this might track down to the implant. Secondly, the view is difficult and if there is bleeding the surgeon may have to make another cut into the breast. Finally, the need for a camera and special instruments makes this procedure longer and more expensive.
An incision is made at the top of the belly button and a tunnel made to each breast. The surgery is done with the help of a camera and long instruments. This procedure has the same problems as the trans-axillary technique. The entry point is in a dirty area, exposure isn’t as good and the operation takes much longer.
2. Breast Augmentation Techniques for Implant Placement
After deciding which scar is going to be used, you need to decide where the implants are placed. Your surgeon will assess you and let you know the best implant placement methods for you. Different breast augmentation techniques are suitable for different people.
This is the simplest type of breast implant placement technique. The breast tissue is separated from the chest wall muscles and the implant is pushed into the space. Advantages include a quick procedure, low risk of bleeding and no muscle damage. This means that recovery is often quick and you can return to sporting activity quickly. However, the disadvantage is that the implant is not held down at the top of the breast and can be more obvious. When looking at the cleavage, others may be able to see the edge of the implant and you may feel it yourself. One way to deal with this is to use a ‘teardrop’ (anatomical) implant which is thinner at the top and appears more natural in shape.
Implants can be placed completely under the ‘pecs’ (pectoral muscle) in the chest. In order to do this the muscle must be partially detached from the breast bone and a pocket made underneath. This causes some damage and trauma to the muscle. It can be more painful and recovery takes a bit longer. However, the muscle hides the shape of the implant well, and any ripples in the implant surface shouldn’t be seen. The muscle pushes the implant downwards and you shouldn’t be able to feel or see the top edge of the implant. This type of surgery works well for women who are very thin or have little breast tissue.
The Dual-plane type of breast augmentation was pioneered by John Tebbetts who is a surgeon in Texas. This method combines the good points of both of the others. Firstly, there is very little cutting of the muscle required and so the pecs stay strong and you recover quite quickly. Secondly, there is some muscle coverage of the top of the implant which hides the edges and keeps the implants in a good place.
Choosing the Best Surgeon for Your Boob Job
Your surgeon should be able to explain all of the breast augmentation techniques to you. If they always use one method and won’t consider another then they should have good reasons. Can they explain their decisions and are they willing to listen to your opinions? You should feel comfortable asking questions and being clear about your hopes. Similarly, your surgeon should be honest about when something can be realistically achieved or not.
When Chris Cartlidge or Lucy Khan do breast augmentation they make detailed measurements and plans beforehand in clinic. Manufacturer implant sized-shells made from ‘gummy-bear’ silicone allow you to see and feel what your result is going to be like. Before you go for surgery you will have marker pen drawings all over your breasts (don’t worry, it comes off!) with numbers, lines and measurements. Our notes look like the technical plans to destroy the death star. We are super-geeks and proud of it!
If your surgeon makes the breast implant ‘pocket’ too big or too small the implant will sit in an odd-feeling and -looking position. Ask how long your surgeon takes to do a breast augmentation? If he/she takes 30 mins (many companies rely on being this quick to make as much money as they can), how careful are they being? Chris and Lucy take 1.5-2 hours to do a careful breast augmentation, and for difficult cases they may work together (2 consultants).