Breast Implants: Pros and Cons of The Four Main Incision Choices.
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Hello! My name is Adrian Richards and today I am going to be talking about the different types of incisions used for breast augmentation surgery. Okay, now you may have read about this, but essentially there are four places, the implant can be inserted by. Number one through the tummy button, number two is through the crease underneath the breast, number three is underneath the nipple and number four is the armpit. So, first of all, let's start, let's work up from the button and then talk about the pros and cons of each. Through the tummy button; is only really used for the saline implants which could be completely collapsed and inserted through a very small incision. And so whereas this type of insertion seems very attractive, we are trying to use saline, which is salt-water-filled implants, which have problems, and potentially leaves some more rippling and deflation. So in England, they tend not to use that approach, I am not aware of any surgeons in England who use the tummy bottom approach principally, because it's very difficult to accurately place the implant. Second incision, which is probably the most common in England, is an incision in the fold underneath the breast and this is most commonly used, because it gives really accurate -- the surgeon can accurately place where the implant is going to go and can actually raise or lower the fold underneath the breast. So, in many people you need to lower the fold slightly beneath the breast, to give a nice gentle curve to that part of the breast. So, this incision is typically 5 centimeters long, located slightly offset of the mid-line in the fold. And when it heals, it's very difficult to see because it's hidden in the natural zone. The third type of incision is around the areola. The areola is the brown area around the nipple, and typically this incision is on the junction of the areola and the breast skin. Now quite attractive approach, not good for people with small areolas because you need 5 centimeter incision to get implanted them without damaging it. So, if you've got a small areola, perhaps not suitable and there is also a slightly high risk of infection because of the excretions from the nipple and also altered sensation to the nipple, which is what many people don't find them. The fourth approach is through the armpit or the axillary approach. This has some advantages. It's slightly more difficult to get the implant in exactly the right position and because of the location of the incision, these implants are put through the armpit and only put under the muscle, so totally under the muscle. The problem with this approach is slightly high risk of infection because of going through the armpit and you can't get altered sensation down there, in respect to the armpit, because there are some very important nerves traveling from the chest to the arm which go through that area. And probably the biggest downside of that particular incision is it's difficult for the surgeon to accurately get the implants of exactly the same height, and required weight down through the pocket created. So just to summarize, there are four types of incisions, tummy button incision, not really used in England. Armpit incision, which is probably used in about 10% of the cases in people who like the idea of an implant under their muscle. And the main incision that's used in England would be the areola incision, probably used in about 20%-30% of cases. And the vast majority of patients have their implants inserted via the fold, with an incision concealed in the fold, and probably 60%-70% of patients in the UK have the implants inserted that way. So, the important thing is really to talk to your surgeon, and then you have think about which way you'd like it inserted, which sort of scar is better for you. Look at the pictures of patients who have had both the approaches, which a surgeon should be able to give you, and have a frank and open discussion out with the surgeon about the options. Thank

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