Part 2 – Incision, Location and Size
When I discuss the best implant choice for a patient I will always bear in mind that everyone is an individual with specific needs and desires, but they all want the best breast implant to achieve the best breast augmentation result.
What you need to consider is the best result will depend on where you are starting from, what you want to achieve, the implant type, material, shape, size and location, as well as the surgeon you choose.
Let’s discuss the incision location and choices, the location of the implant, and the size of the implant.
Incision Site and Final Scar
There are three common choices for incisions:
1. Under the fold of the breast (the infra mammary fold)
2. Around the nipple
3. Through the armpit
Each of these incision sites have advantages and disadvantages in terms of how well the scar is hidden. A scar not on the breast that is offered by the armpit incision may seem appealing, but it will be visible in a singlet top or bikini top. Incisions around the nipple may be well hidden but scars can fade and become paler than the nipple pigmentation and be visible, and can also alter and decrease nipple sensitivity
The commonest location is under the fold of the breast; the scar is hidden on a day to day basis and offers reliable surgical access with no alteration in sensation to the nipple.
Since everyone is different, you will likely prefer one incision site over the other. It is your choice where the incision is placed. I will explain the pros and cons of each site and answer any questions you may have.
Incisions in the tummy button known as trans umbilical incision do exist but can be fraught with difficulty and are only used if a saline implant is being used.
Implant Location – Prepectoral, Retropectoral, In Front or Behind the Muscle
An implant can be placed in front of or behind the muscle and each location will achieve a different result.
The common locations are:
1. Retropectoral/ Submuscular – behind the muscle
2. Prepectoral/ Subglandular – in front of the muscle
Generally speaking, in front of the muscle will create a more mobile breast and will give you more upper pole fullness. This may sound appealing but with little coverage at the upper pole the appearance of stepping onto the implant and the roundness of the implant can be visible. For some this is an appealing appearance and is more obvious that an implant is in place.
Placing the implant behind the muscle in the subpectoral plane will create a smoother transition from the chest onto the upper pole of the breast with a more natural ramp leading down to the nipple. This limitation of this location though is that when the pec muscle is flexed it will distort the shape of the breast. This is usually acceptable though depending on how physical your lifestyle is.
Implant Size/Volume – “Bigger Is Better – But Not Too Much”
It seems obvious that the larger the implant the bigger the result it will achieve and for some people this is their objective with breast augmentation – “big is better”
For others though a natural proportioned enhancement is the key and “bigger is better – but not too much” often applies.
I use a sizing system preoperatively to allow you to add volume to a bra to achieve the desired result you want. This will then tell me what volume I need to add to the volume you already have to achieve the result you desire. It is what you see in the mirror that counts and what you call a full C cup others may call a large B or D cup. The result you want is the ”look” you want and it is vital the volume is right to achieve this. After all, what an implant looks like on a desk is irrelevant it is what that volume achieves when you are upright and wearing a bra that counts.
Everyone is an individual with specific needs and desires and the best result for you will need a combination of implant type and location as well as size to create your desired breast augmentation result.