Whenever a person has surgery that requires any incisions, there will be scars. The question is how large and/or visible will they be?
What is a scar?
A scar is the body’s attempt to heal a wound, whether a cut, abrasion, burn, puncture, or other type of wound. At the place where the skin’s integrity is breached, tissue forms to fill that gap. It forms itself across the wound and eventually contracts to pull the wound edges together tightly.
Over time, scars usually fade and shrink, becoming les and less visible.
Four possible locations for the breast augmentation incisions
You can choose:
1. In the armpit;
2. Under the breast crease;
3. Around the areola; or
4. In the belly button
1. In the armpit (axillary incision)
This incision is about an inch long and can only be seen when you raise your arms above your head. Even then, when it’s fully healed, it will be only a very thin faded line.
From this location the surgery is done endoscopically, a technique developed in the 1990s. The cosmetic surgeon uses a hollow, flexible tube called an endoscope, which has a light on the end and is connected to a television monitor. Surgical instruments can be inserted through the endoscope and the surgeon can see his work on the TV screen.
Since the implant must travel from the incision site to its final location, only a smooth-surfaced implant will be used with the axillary incision.
2. Under the breast crease (inframammary crease incision)
This incision is 2 to 3 inches long and runs along the underneath of each breast, very slightly above where the breast meets the chest wall. With this method, the cosmetic surgeon has easy access and a full direct view of his work. The scar will be a thin faded line when it’s fully healed and only visible on close inspection.
If any second surgery is required to correct a post-op condition from the original implant surgery, this incision site will be the one used.
3. Around the areola (peri-areola incision)
A very small semi-circular incision is made around the lower edge of the areola (the darker colored area around the nipple). The resulting scar will be virtually invisible because the changes in skin texture and coloration will camouflage it well. However, future breastfeeding will be unlikely, as the milk ducts and/or nerves are damaged with this incision.
4. In the belly button (trans-umbilical incision)
This one is known as the TUBA incision (Trans-Umbilical Breast Augmentation) and is a little curve inside the belly button. With this location, only one incision is needed for both implants, instead of two, (one of the left and one on the right).
Your breast surgeon will create a tunnel from the incision up to the implant locations behind the breast tissue. As with the axillary incision, the implants inserted from the belly button incision will have to travel to their final locations, so only smooth-surfaced implants are used.
The scar in this method is visible only upon close inspection, and is only the size of the belly button’s lower edge.
A limitation is that the implants can only be positioned over the top of the chest muscle (sub-glandular placement), rather than underneath it (sub-muscular placement). This means that sometimes the outline of the implants can be seen through the skin (if the woman is thin), and that sometimes they will start sagging, since they lack the support of muscle under them vertically. (The sub-muscular placement has muscle both over the front side of the implants, and under the lower edges.)
Smooth-surfaced vs. textured implants
When the breast implant is placed directly into its final position, as with the breast crease and peri-areola incisions, and doesn’t have to be moved along any tunnel to get there, a textured implant is often used.
Textured implants feel like fine sand paper.
Smooth implants have a polished feel and can be more easily maneuvered into position. They have thinner shells and last longer.
How should we care for an incision site?
Surgical tape
Usually there’ll be surgical tape on the site, covering the stitches. The purpose of this is to minimize tension on the incision. If it’s removed too soon, the edges of the incision can be pulled apart a little, which will trigger the creation of more collagen to fill that gap. The resulting scar will be bigger than necessary.
So the first thing is to leave the surgical tape on until it comes off by itself, which may be a month or more.
After the surgical tape comes off
In the early weeks, the scar will be pink and firm and for several months might not change its appearance much at all. At some point, the pinkness will start to fade and the scar will become more narrow and flat. Eventually it may shrink to a very small line, but will not evaporate altogether.
Lotions and creams
Some plastic surgeons recommend various salves and ointments to maximize healing. They might suggest Vitamin E cream or rose hip oil, or a commercial product such as Mederma or Neosporin. However, other surgeons recommend not using such products, either because they’re thought to be ineffective, or because in some cases they have led to negative results.
You can ask your cosmetic surgeon for his advice, but whatever course of action you then take, be consistent about it for best results.
Finding a good cosmetic surgeon
Since cosmetic surgery has become so popular in the last 10 years or so, some doctors have taken short cut training to take advantage of this at a disservice to the general public. You want a properly trained and experienced breast augmentation surgeon, not one who might gain his basic experience on you! Choose a plastic surgeon who’s certified by the American Board of Plastic Surgery (ABPS), and one who’s a member of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS).
While you should by all means listen to your friends and acquaintances who may have had cosmetic surgery and want to recommend their doctor to you you should do your homework too, and check the doctor’s credentials.
Some questions to ask when interviewing plastic surgeons
Do you have hospital privileges, and if so, which hospitals?
Can you do the procedure in the hospital if I want to?
If you do surgery in other facilities, are they accredited?
How many breast reductions have you done?
Can I speak to some of your previous patients about their experience with it?
Click here for more information about breast augmentation or other cosmetic surgery procedures in the Orlando area.