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Site of
incision Allowing the patient to choose the site of
the incision may sound like an upsetting idea to some surgeons, but more than
98% of the patients will accept the doctor's recommendation anyway, so why not
allow the patient to have as much say in the matter as possible? For the patient whose breasts droop enough so
that the skin of the breast is touching the skin of the chest wall when standing
erect, the inframammary incision placed slightly up on the breast just 1/2 to 1
cm above the new inframammary fold should be almost completely hidden, and may
be the preferable and most recommended sight. In the patient with very small areolae, the
areola incision may be nearly impossible. It is preferable to have this incision
at least 2 cm long, and if it is to be less than 1.5 cm and the patient really
insists on not having it under the arm, we may insist on permission to extend it
laterally as much as 1/2 to 1 cm in each direction because it may not be
possible to get an implant of over 200 cc volume through it. Ordinarily we tell our patients the
following: 1.) The areola incision made in the wrinkles of the brown skin of the
areola heals with the least scar, 2.) The inframammary incision is most visible
of all except in pendulous breasts, and 3.) The axillary incision is the least
visible of all, unless the patient is a ballet dancer or for some other reason
has her arms in the air with the axillae exposed very frequently. The techniques of the different approaches
and associated problems will be discussed in detail in further chapters. The
patient may wish to know that the areola approach is the only one of the three
that invades the breast tissue; yet in performing this in hundreds of women and
knowing others who have also done hundreds with this approach, I have yet to see
or hear of breast nodules or cysts developing in the lower portion of the breast
because of this approach. Many patients I have done with this approach have
subsequently become pregnant and were able to breast-feed. Also, with the areola approach there has been
no greater incidence of hypaesthesia (numbness) of the nipple or lower breast
skin than with the other approaches in my experience of performing more than 500
surgeries using areola incisions. There is an article in the literature that
states that patients who have the areolar approach have more difficulty
breast-feeding than those with the axillary or inframammary incisions. This is a
retrospective study and is unreliable, but the suggestion may still be correct. |
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The American Society of Cosmetic Breast Surgery 2018 Last modified: September 18, 2021 |