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I am a 37 year-old African-American female who has decided to have breast...

Q:

I am a 37 year-old African-American female who has decided to have breast augmentation surgery. My question relates more to the optimal location for the incision (under the armpit, around the areola or in the crease of the breast). Although I personally have no problems with keloids, I would prefer minimal to no scarring on the breast. Also, I am still planning on having children, so I would prefer minimal interference with the nipples.

A:

The best location for the incision depends on individual patient factors including the shape and size of the breasts. If possible, I prefer an incision at the lower border of the areola (the pink skin around the nipple). However, given your specific concerns, it is important for you to have a personal consultation a qualified plastic surgeon who can give you the best advice for your particular situation.

A:

 

   

Three incisional approaches are commonly used for breast implant insertion: trans-axillary (underarm area), peri-areolar (from about the 4 to 8 o'clock position of the areolas), and inframammary fold (in or just above the crease below the breasts). No two patients are alike, so it is important to individualize the surgical plan for each patient's individual needs.

An advantage of the peri-areolar incision is that the color and skin texture difference between areolar skin and the adjacent breast skin conceals the resulting scar very nicely. In many patients the scar is almost undetectable after only a few weeks. This incision is commonly used in patients who have had one or more pregnancies and have a medium to large areolar diameter.

The axillary or underarm area incision is ideal for patients with very youthful-appearing breasts, especially younger women with no history of pregnancy. These patients often have a small areolar diameter, which makes the peri-areolar incision less than ideal, and smaller, perkier breasts - where the inframammary fold (and thus a scar in that location) can be easily seen.

The infra-mammary fold incision works very nicely for patients who do not have a marked color difference between areolar skin and breast skin, and who have adequate fullness in the lower pole of the breasts. As full breasts conceal the infra-mammary fold very well, the scar is usually not visible when standing or sitting upright. Ideally this scar is placed just above the inframammary fold on the lower pole of the breast, so that it faces down and therefore tends to be less noticeable.

Breast implants can be inserted through a limited incision in the belly button area, however there are a number of problems with this approach and it therefore is not widely used. Approaching the surgery from such a remote location does not lend itself to the creation of a precisely-defined implant pocket, or the creation of a natural-appearing result.

     

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