There are four common choices for the placement of breast
implants.
Placement through the belly button claims to eliminate any scarring in the area of the
breast. This procedure is not as difficult as it may sound. I think that this is not the best choice, however, because it is difficult to impossible to insure
that the implant is actually covered by muscle without disrupting the lower portion of the muscle itself.
Placement through the armpit leaves small but visible scars which can be seen
when you raise your arms. While this may be acceptable to many people, the real question
mark with this operation is that at least two papers have shown that there may be a
higher possibility of permanent loss of feeling in the nipples. To confirm that this makes sense, look at the anatomy of the 4th intercostal nerve. It starts at the spine and follows the 4th rib right around through the armpit. I believe that if we avoid the course of the nerve through the armpit that there is less of a chance of loss of feeling.
Placing the incision in the fold under the breast is okay. The nerve is not in that area. But when lying down while wearing
a halter top or a bikini, the scar can be visible. The surrounding skin is all one color
and the scars often quite apparent.
I favor placing implants through an incision made at the lower edge of the areola
in most cases. The
incision that you need to make is relatively small. There is a natural color change where the
areola changes to breast skin. This usually hides the scar well. The areola also tends to heal well just like lips tend to scar less that your cheek.
While there is no RIGHT answer to this question, and nobody is WRONG for choosing any
of the above incisions, for the above reasons almost all of my breast implants are placed
through peri-areolar incisions. As seen in the before and after pictures, the resulting line is not very objectionable in the vast majority of patients and loss of feeling is very unusual.
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