Breast augmentation today has seen silicone gel implants not only return to availability but become more commonly used than saline implants in most plastic surgery practices. The improved feel, lack of any significant rippling, and no potential for spontaneous deflation have made silicone the preferred implant filler material for many breast augmentation patients despite its higher costs.
Silicone implants, however, require some incision modifications over those used for saline. Because silicone implants are prefilled, they have to be inserted fully inflated unlike saline which is inflated after it is in place. Because these incisions are going to be bigger, using the armpit or nipple locations is usually inadequate. Therefore, the lower breast crease or inframammary fold is most commonly used. This provides direct access to getting under the muscle and the length of the incision is not so critical as it is ‘hidden’ on the underside of the breast. This is also an area that does well from a scar healing standpoint as it runs parallel to the relaxed skin tension lines of the body in this area.
As the silicone implant can only be deformed so much by squeezing it through a hole (incision), the size of the incision is important. While there are no absolute rules as to the size the incision must be, it should generally be about 1/3 of the base diameter of a silicone implant. This permits the implant to not be overly compressed during insertion, protecting the implant’s shell and lessening the long-term likelihood of implant rupture.
While the natural lower breast crease is usually a good place to put an incision on the breast so that it is the least visible, its placement in one’s existing crease may not always be best. In many breast augmentations, the bottom part of the breast must be expanded so that the a new and lower breast crease will actually be established after. Remember breast implants make the overall breast bigger in all dimensions and this includes the lower pole. For this reason, particularly in larger breast implants, the incision must be made lower than the existing lower crease so that it does on the breast itself after.
Dr. Barry Eppley
Indianapolis, Indiana