Breast Augmentation With Implants
Breast augmentation is a well-recognized procedure, and most patients know all about it. I frequently get asked the question, what is the difference between making the incision at your axial, the infra mammary fold (IMF), or around your areola and which one is best? My answer is always your preference, however, an educated patient always makes smart decisions. The complication profiles between the three incisions are different, and you should know what those differences are to make an educated decision.
The capsular contraction rates, and infection rates (requiring removal of your implants) are higher if you use the areolar incision. The rates of your implant being in the wrong position, such as a double bubble (implant to low), high riding implant (implant to high), symmastia (both your breasts becoming one across your chest from the implant being to medial), and lateral displacement (implant to lateral towards the axial) are higher if you use the axial incision. Lastly, the incision at the infra mammary fold has the disadvantage of having a potentially visible scar. However, the risk of all the above complications is way lower with the infra mammary fold incision. If you use the technique of placing the incision at the concave surface, which is the technique I use, the scar is not visible in almost all patients. This is a powerful technique that can lead to excellent results.
The question of silicone versus saline always comes up, and most of my patients come into the office already knowing they want silicone implants. Silicone feels more natural, they are more dynamic, and the implant moves and sits on your breast mimicking your own breast tissue better than saline.
What about placing the implant above or bellow the pectoralis muscle? The key to making this decision is whether you are an active person that uses your upper body (chest muscles) to exercise or stay active. Placing the implant under the muscle, contours the implant, and hides the edges of the implant better. In addition, under the muscle minimizes rippling and capsular contraction rates. However, if you are an athlete or use your chest muscles in your active life or exercise program the implant can be animated and move up and down when you activate your muscles. Therefore I recommend placing the implant above you muscle for this reason.