How to choose your incision?

4 types of incision (or approach) are possible when placing implants:

1: The submammary approach: this is the most commonly used approach in the United States, and is mainly reserved for patients who already have a marked submammary fold (crease under the breast).

- In most cases, this means that breast augmentation with implants can be performed on an outpatient basis (in and out of the clinic on the same day), with no drains and little pain.

- It avoids contamination shells (biofilm), as it does not cross the mammary gland.

- It easily accommodates implants larger than 400 cc.

- It causes few areola sensitivity problems

- Thanks to endoscopic techniques (using a camera) and the Keller Funnel introducer, we can produce short scars of less than 3 cm.

2: Axillary approach: the scar is located in a fold of the armpit.

With the advent of the endoscopic technique (using a camera), we can precisely control the location of the prosthesis and bleeding, to avoid prostheses that are too high and haematomas. This is an interesting option when the areolas are too small to insert a prosthesis. On the other hand, this technique is more time-consuming, more expensive and requires a number of pot-operative re-education sessions to avoid the formation of bridles (hard fibrous cords) in the armpit.

3: The trans-areolar approach: this is an inconspicuous scar that only accepts inflatable serum implants or silicone implants with a volume of less than 250 cc. It often results in nipple sensitivity problems.

4: The inferior peri-areolar approach: We use this approach in 20% of cases, particularly in cases of ptosis. It allows precise control of the breast space and placement of a prosthesis with a volume of up to 450 cc, depending on the diameter of the areola.

On the other hand, it has a few drawbacks:

- the shell rate is increased, as the biofilm (bacterial film) in the galactophore ducts (ducts carrying milk to the nipple) responsible for over 80% of shells is released as the implant passes through the gland to access the muscle. We therefore systematically use polyurethane foam-covered implants in cases of peri-areolar scarring to limit this phenomenon.

- more sensitivity problems with the nipple and areola

- very rarely, retractive flanges may occur, deforming the areola.

Have a question? Please contact us.


The firm

Docteur Yaël Berdah and Docteur Marc-David Benjoar
Plastic surgeons in Paris France

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