Breast augmentation surgery usually involves the insertion of breast implants into the chest wall to enhance the size of the breasts. If we use implants for breast augmentation, they are inserted into a pocket either below the breast tissue or below the pectoral muscle, or in some cases partially under each. Implants may be round or anatomically shaped; their surface may be smooth or textured; the contents may be silicone or saline, and there are advantages and disadvantages with each option. Some breast implants are more expensive than others; if you are looking for state of the art breast enhancement or simply the most cost effective solution and the best value for money, we can find a product to suit your needs.
We like to use the latest generation form stable silicone gel implants. These breast implants are cohesive gel, which means the implants will never leak silicone. The implants are also biodimensional, which means I take measurements of you at the time of consultation and I ask you what your requirements are. Using a combination of measurements and desired results, together we choose an implant that has the right width and projection for your breast augmentation surgery.
Different surgeons will use different breast implants for various situations, and most will be more than happy to justify what they're using and why. This can sometimes be an important part of the discussion during the consultation and at the end of the consultation both your surgeon and you should be happy with the choices made.
The implants need to be placed within a pocket. There are three types of pocket and the best place to put the implant depends on the characteristics of the breast being enhanced, the implant being used and the desired look. We will discuss this at the time of your consultation.
The submuscular pocket is often referred to as "under the muscle", as the pocket is made under the pectoral muscle of the chest wall. This pocket is often used in women who have minimal breast tissue so that the top of the implant is hidden under as much of your own tissues as possible to prevent a sharp take off of the breast and to reduce the chances of the implant being felt or seen. However, it can lead to the muscle being pushed forward on top of breast tissue which slides down as time goes by. This can lead to a “double bubble” problem where there are two bulges on the chest wall which may need further surgery for correction.
This pocket is often referred to as one which is made "on top of the muscle". The "sub" part of subglandular means "under" and the "glandular" part refers to the breast itself. So, the subglandular pocket is made under the breast, on top of the muscle. This pocket is often used when there is already a reasonable amount of breast tissue in someone who has little projection but is generally flat. It can also work well in someone who already has a reasonable breast volume but simply wants to be larger and is also used when someone wants to have an enhanced look following their surgery. It can also be used in someone who has a low take off and some concavity in their upper pole who wants to have an enhanced look
Dual Plane Pocket
The dual plane pocket is one that is made partially on top of the muscle and partially under the muscle. It involves splitting and releasing the muscle at exactly the right point so that you can have the benefits of having some of the implant above the muscle and some of the implant below it. This is often used in women who have a low take off and little tissue in the upper pole of the breast. By using a dual plane approach, what we achieve is to get the upper part of the implant hidden by the muscle but we prevent the appearance of two bulges in the breast (the double bubble effect) because of the low take off of the breast tissue by placing the lower part of the implant above the muscle. It is only possible to use an inframammary crease incision for the dual plane approach but in some people this is the best way of achieving the most natural look.
The incision is where the surgeon makes the cut in the skin so that the implants can be inserted. A breast augmentation may be performed using a number of incisions: the incision used depends on patient preference, the type of implant used and after a discussion of the advantages and disadvantages of the various incisions.
Inframammary Fold Incision
An inframammary fold (IMF) incision is one placed near the region where the breast tissue meets the chest wall. This incision is usually very well hidden after the procedure and for most implant sizes the length of the incision is limited to a few centimetres. For inserting very large silicone implants, the incision may have to be longer and you should discuss this with us at your consultation. These scars will only be seen from underneath and when placed well, they will be in line with the inframammary crease, meaning they will be very well hidden.
A periareolar incision is one placed around the lower half of the nipple/areolar region as a semi-circle just inside the outer border of the areolar and is only suitable for women with large enough areolars to accommodate the size of the implant being inserted. If you are having saline implants inserted then it is quite rare for the areolars to be too small to use. Although periareolar incisions usually heal very well and are often barely visible, incisions around the areolar will always be seen by someone who is looking very close to the breast. There is always the risk that an incision does not heal with an almost invisible scar, and a prominent scar on the areolar may not be the best position for a prominent scar.
An axillary incision is also known as an armpit incision. Usually saline implants only can be inserted this way; silicone implants need to be squeezed and pushed too far into the chest with an axillary incision, whereas saline implants can be inserted into the pocket and inflated once they have been pushed through the small incision. The advantage of the incision is that there is no scar on the breast, however, there is a greater theoretical risk of bleeding and infection after this type of incision. In addition, the scar usually takes longer to fade in comparison to periareolar and inframammary fold scars.
The Tuba Incision
A TUBA is a trans-umbilical-breast-augmentation. In this, the incision is placed near the belly button (the umbilicus), a tunnel is made using a blunt dissecting instrument and a saline implant passed into the breast pocket. The implant is inflated once it is in place. The advantage of this incision is that there is no visible breast scar at all, however, special instruments are required and the implant placement is a little more imprecise in comparison to some of the other methods of pocket creation. Imprecise pockets can lead to asymmetry after the operation which may have to be corrected using one of the other incisions (eg the inframammary fold incision). Please note that I do not perform breast augmentation surgery using this technique.
A nipple lift or breast uplifting procedure can be performed at the same time as a breast augmentation. In these cases, your incisions will be placed all the way around the nipple and may go down the breast and along the inframammary fold at the same time - either as a round incision, a lollipop shaped incision or an anchor shaped incision. The type of incision during a combined lift and augmentation depends on how much lift needs to be done, whether the size of the nipple needs to be reduced at the same time and how much of the shape of the breast needs to be changed.
For a consultation on breast augmentation surgery please contact us today.