The popularity and success of breast augmentation has more women than ever before seeking out the procedure. Besides the type and size of implant used, women are equally concerned about the incision which is used to get the implant in place. While scar placement and visibility is usually quite good with any of the incision options, the more hidden and obscure the better.
The best hidden scar location for breast augmentation is a matter of debate amongst different plastic surgeons. But it is fair to say that an incision off the breast is more hidden than any on the breast, no matter how well a scar on the breast may look. A truly hidden breast scar is one that isn’t on the breast at all.
There are only two breast augmentation incisions that qualify for this hidden criteria, the armpit or the belly button. While a few plastic surgeons may tout the belly button approach (TUBA), the problem with this hidden incision is that it has a higher risk of implant-related problems (e.g., positioning, symmetry) than any other approach. This is not a good trade-off for this one benefit. That leaves the best hidden scar approach as the transaxillary (armpit) breast augmentation technique.
Placing breast implants through the armpit is done through one inch incision high up in one the armpit skin creases. Such tiny incisions can be used because the technique primarily use saline breast implants. They are inserted in a deflated manner, rolled up like a burrito and inflated after they are in place. Silicone implants can be used but they must be fairly small in size (450cc or under) because they are pre-filled from the manufacturer. Any silicone implant larger than that size must be really stretched and pulled to get in which is not good for the containment bag of the silicone gel. Blunt dissection is used to get under the pectoralis muscle and create the pocket for the implant. Some plastic surgeons use an endoscope to make this dissection but I do not find it necessary to do so. Once the implant has been positioned, the surgical wound is closed, with care taken to do a fine skin closure with dissolveable sutures.
For women who prefer scarless breasts, the hidden armpit incision is the preferred method. Incisions in the armpit are easily hidden by the natural fold of the arm. Even with the arm raised, the scar in the armpit heals so well that it can rarely be found. The warm moist skin of the armpit, combined with being hair-bearing skin, allows incisions to heal very favourable.
The hidden scar breast augmentation is particularly advantageous for women whose skin has more pigment. Ethnicities such as African-American, Asian and Hispanic are particularlykeen on keeping the scar off of the breast due to their tendency to hyperpigment and/or widen.
Dr. Barry Eppley
Indianapolis, Indiana