Dear K.T.
   As with all aspects of surgery, there is no one single approach, or incision, that is ideal for every
woman. I will use one of three types of incisions in my patients; in the fold (Inframammary), around
the areola (Periareolar) and in the armpit (Transaxillary). I do not recommend the umbilical approach
because of concerns of implant damage, asymmetrical placement of the implants and limitations on
positioning of the implant.
  Saline implants are inserted while they are deflated and then filled once they are positioned under
the breast, they can be inserted through a very small incision. Typically, the incision used for a saline
breast augmentation is 3cm long. Common approaches for saline breast augmentation are in the
fold under the breast, around the areola or in the armpit.
   Cohesive gel implants are inserted intact, and therefore they require a slightly longer incision.
Typically, the incision needs to be 5cm in length. Because of this, the approach is usually in the fold
under the breast although it can be done around the areola or in conjunction with a mastopexy
(breast lift). Cohesive gel implants cannot be inserted through the armpit.
   It is important to discuss incision location very carefully with your surgeon. Different patients are
better candidates for a certain incision location. For example, if a patient has a well-developed fold,
then the fold incision can be very nicely hidden. Alternatively, if the patient has a large and darkly
pigmented areola, then the areolar approach may be best for hiding the incision. For patients with
minimal or no sagging, absence of a well-developed fold and a smaller areola, the armpit incision
may be best. It is important for you to review the advantages and disadvantages of each approach at
the time of your consultation.
Dr. Mitchell Brown, B.Sc., M.D., M.Ed., F.R.C.S.C
www.torontobreastimplant.com
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