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Site of incision

Allowing the patient to choose the site of the incision may sound like an upsetting idea to some surgeons, but more than 98% of the patients will accept the doctor's recommendation anyway, so why not allow the patient to have as much say in the matter as possible?

For the patient whose breasts droop enough so that the skin of the breast is touching the skin of the chest wall when standing erect, the inframammary incision placed slightly up on the breast just 1/2 to 1 cm above the new inframammary fold should be almost completely hidden, and may be the preferable and most recommended sight.

In the patient with very small areolae, the areola incision may be nearly impossible. It is preferable to have this incision at least 2 cm long, and if it is to be less than 1.5 cm and the patient really insists on not having it under the arm, we may insist on permission to extend it laterally as much as 1/2 to 1 cm in each direction because it may not be possible to get an implant of over 200 cc volume through it.

Ordinarily we tell our patients the following: 1.) The areola incision made in the wrinkles of the brown skin of the areola heals with the least scar, 2.) The inframammary incision is most visible of all except in pendulous breasts, and 3.) The axillary incision is the least visible of all, unless the patient is a ballet dancer or for some other reason has her arms in the air with the axillae exposed very frequently.

The techniques of the different approaches and associated problems will be discussed in detail in further chapters. The patient may wish to know that the areola approach is the only one of the three that invades the breast tissue; yet in performing this in hundreds of women and knowing others who have also done hundreds with this approach, I have yet to see or hear of breast nodules or cysts developing in the lower portion of the breast because of this approach. Many patients I have done with this approach have subsequently become pregnant and were able to breast-feed.

Also, with the areola approach there has been no greater incidence of hypaesthesia (numbness) of the nipple or lower breast skin than with the other approaches in my experience of performing more than 500 surgeries using areola incisions.

There is an article in the literature that states that patients who have the areolar approach have more difficulty breast-feeding than those with the axillary or inframammary incisions. This is a retrospective study and is unreliable, but the suggestion may still be correct.

 

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  1984-2014 American Society of Cosmetic Breast Surgery  Last modified: March 28, 2014