Breast Enlargement Surgery Options

There are four approaches for breast enlargement surgery:

Transumbilical (TUBA)

– implants are placed through the belly button

Transaxillary (Armpit)

– the implant is placed through an incision in a armpit crease

Inframammary

– an incision is made under the crease of the breast

Periareolar

– incision is made around the edge of the pigmented area surrounding the nipple.

As with any surgery a comprehensive consultation appointment will be made, at that time your surgeon, Dr. Mok or Dr. Kotlus will discuss all the options and help you decide which procedure is best for you.

The most requested breast augmentation surgery is the Transumbilical (TUBA). This is the placement of saline filled implants through the navel. TUBA is often referred to as “scarless” as only a small incision is made in the belly button- almost undetectable after it is healed. Other advantages of this procedure are less post-operative pain, less risk of infection and less potential damage to the nerve endings, particularly around the nipple. With Transumbilical Breast Augmentation you still have the option of placing the implants above (subglandular) or under (submuscular) the pectoralis muscle although placement under the muscle can sometimes cause more post-op discomfort. The majority of our patients choose under the muscle placement.

Placement options:

Submuscular

– The implant is positioned under a layer of muscle in the chest wall. With submuscular placement there is usually less risk of capsular contracture and less interference with mammograms.

Subglandular

– The implant is placed on top of the pectoralis muscle behind the breast tissue. There is less pain associated with this placement, however based on your particular body, it can be associated with more visible implant edges, or rippling.

Subfascial

– The implant is placed under the lining of the pectoralis muscle. It is sort of an “in-between” placement above or below the muscle. Sub-fascial placement combines many of the benefits of both submuscular and subglandular placement. The sub-fascial approach is desired by some as there is less pain and the subfascial position prevents the stuck on appearance caused by the interruption of the clavicle to nipple.

Placement under, over, or in between the muscle is determined by the thickness of your existing breast tissue, and the amount of sag or firmness to your natural breasts. Dr. Mok or Dr. Kotlus will help you determine what is best for you. In general, a smaller or firmer breast will have the implant placed under the muscle, as it will be more difficult to feel the implant when it has the extra layer of tissue over it. For women with a fuller breast, the placement does not have as much impact; the implant is harder to feel as there is more breast tissue overlying the implant. For a moderately droopy breast, it is often best to place the implant over the muscle otherwise the appearance of sag will increase.

The Transumbilical (TUBA) Surgery Procedure

With Transumbilical (TUBA) Surgery implants will be placed above (subglandular) or under (submuscular) the muscle. First a surgical path is marked on the skin. Then a small incision is made in the navel. The skin is loosened around the area and an endotube (surgical tube) is passed under the skin in the pre-determined path to the implant's desired location. A tissue expander is then slid through the tube into the breast and filled this allows for separation of the breast tissue from the chest. Once the expander is removed the actual implant is then passed through the tube and placed into the newly formed ‘breast pocket”. It is then filled to the desired volume. The endotube is then removed and the implant is in place. The navel incision is sutured and the patient is wrapped in pressure bandage and will soon be ready to go home.

 

Transaxillary Breast Augmentation Procedure

The transaxillary incision is made in the natural folds of the armpit, a channel is created to the breast, (an endoscope may be used so that the implant can be moved through the tunnel) the implants are properly positioned behind the nipple either submuscular, subglandular or subfascial. The incision is sutured and the patient is wrapped in pressure bandage.

 

Inframammary Breast Augmentation Procedure

Inframammary breast augmentation is where an incision is made at the base of the breast; any scarring is generally well hidden as the incision resides in the crease of the lower breast. Since the incision is so close to the location of the implant, it is commonly used in revisions and corrections of breast implant surgery. With this procedure implants are placed either submuscular or subglandular. Your Surgeon will first determine the best location for the incision to secure proper placement of the implant and to create as little visible scarring as possible. After the incision is made a pocket is created in which to place the breast implant. The implant is then slid upward through the incision and positioned behind the nipple. The incision is sutured and the patient is wrapped in pressure bandage. Any scarring from properly located inframammary incisions are easily hidden under a swimsuit top.

 

Periareolar Breast Augmentation Procedure

The periareolar incision is made around the edge of the pigmented area surrounding the nipple (areola) and is usually difficult to see when it is finished healing. This approach is one of the preferred procedures for any type of revision surgery. A pocket is created then the breast implant is placed through the incision into the pocket (either placed submuscular, subglandular or subfascial). Once inserted, the implant is then centered behind the nipple. The incision is sutured and the patient is wrapped in pressure bandage.