Breast augmentation approach, under arm or under breast?

8:45 AM

If you have decided what kind of implant to use, then you would be thinking where to incise.

A majority of the papers and literatures about breast augmentation worldwide mentions the under breast line approach is the excellent way for this surgery.

Despite the relatively inconspicuous appearance of the other resulting scars, many surgeons find the inframammary fold approach to be the most attractive optioin when comparing operative exposure with scar quality and its location. (Surgery of the Breast, Scott L. Spear, 2006. Lippincott Williams@ Wilkins)

Reasons for popularity of the inframammary approach include  direct vision for optimal control, minimal tissue trauma, and minimal bleeding. As a result, inframammary approach sets a standard based on logic that is currently unmatched by any other incision approach.
(Augmentation mammaplasty, John B. Tebbetts, 2010, Elsevier Inc.) 

In addition to these mentions from the breast surgery experts, the under breast line approach technique is getting more and more important because we are using the anatomic shaped implants after the FDA approval.

The anatomic implants should be inserted through the under breast lines for most cases.

But in Korea, many surgeons are not familiar with the under breast approach technique because, many Korean young ladies have been preferred the arm pit technique.

Today I'm posting about the under breast approach technique.

Below is a simple chart for comparing each of the approach techniques.

1) arm pit approach

This is recommendable for the people who mind the scar because the incision is located far off the breast. But the field of vision is very limited so it needs endoscopy - the op time could be delayed -.

And who takes this surgery has to keep in mind that it can make some tissue trauma along the long pathway from the entrance to the breast under line.
And the insertion is difficult for the form stable anatomic implants thru the armpit and,  the surgeons need more data about the chance of rotation after the operation with this approach because it is difficult to correct the position of the implant thru the armpit.

2) nipple approach

For many cases periareolar incision approach is a very good way for the augmentation, especially for whom has drooping breast. It can make a good combination of mastopexy with augmentation. 

But this technique should cut down the parenchyma of the breast to make the pocket, therefore could damage the mammary tissue. And there is possible chance for the implants to be contaminated by the normal bacteria living in the mammary glands. The tissue infection can bring inflammation and it could be a risk factor for the capsular contracture.

Insertion procedure is not a dilemma if one has a wide enough areolar diameter . 

3) Under line approach

The visual field is always essential for every kind of operations.
Breast under line technique presents the best direct visual  field among the whole approach techniques.
So it is the safest and, makes the least trauma. So it has the minimal invasiveness.

If a surgeon is blind and operates with just the perceivablity and the experiences, then the result of the operation would be fluctuated. This technique has the best consistency.

The form stable anatomic implants can be inserted easily with the under line approach.
The scar of this skill could be covered up by the impending breast tissues and it would be inconspicuous except some special cases.

4) navel approach

The scar is very far off the breast with this technique, and the pain is minimal.
But it is impossible to insert cohesive gel silicone implant, so is the anatomic shaped silicone implants. And this technique just allows the subglandular placement for most cases. Dual plane placement of the implant is almost impossible.

That's it for today's posting and Thanks for reading.  Have a nice day. 

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