One of the first questions a woman asks when consulting with Dr. Khalifeh at either his Frederick, Maryland or Chevy Chase, Maryland location about breast augmentation surgery is, “Where is the incision?”  There are several different incision sites for this procedure. Each site has distinct advantages and disadvantages.

The periareolar incision is one of the most popular incisions among surgeons because the scar is camouflaged and heals well. The incision is made around the edge of the areola, the pigmented skin that surrounds the nipple.  This incision allows the placement of the implant either under the glandular tissue or under the pectoral muscle. It is easy for the surgeon to work here because the incision is so close to the treatment site.  If any problems arise later, this same incision site may be reentered. Saline implants can be rolled up and inserted directly into the implant pocket. Disadvantages include the rare occurrence of loss of sensation to the nipple. This type of incision is associated with possible problems with breastfeeding because milk ducts may be disrupted. Also, infections may occur that are caused by the implant coming into contact with normal bacteria of the milk ducts.

The inframammary fold or crease is where the underside of the breast meets the chest wall. An incision here is the inframammary incision.  It allows the surgeon to place the implant over, partially under or completely under the pectoral muscle of the chest wall. This incision allows the cosmetic surgeon to work closely on the breast. If a revision is necessary, the surgeon can reenter the tissue there without making an incision at another site.  Compared to the periareolar incision, there is a decreased chance of bacterial infection. When the breasts are very small or there is no natural crease, the incision may not be right on the inframammary crease. Revision surgery, whether reduction or an augmentation, will result in a change in the location of the inframammary fold. This means that the scar may become visible.

The transaxillary or underarm incision does not leave any scar on the breasts. This incision allows the implant to be inserted through the armpit. Once the incision is made, a channel is made to the breast and the implant is inserted and placed either above or below the pectoral muscle. The axillary scars are inconspicuous and incisions placed in the armpit cause fewer breast feeding complications. Any future revisions result in another incision on the breast causing an additional scar. The transaxillary incision does not allow silicone implant placement because they are prefilled and cannot be compressed for movement down the channel. This type of incision results in a higher percentage of asymmetrical breasts because it is quite difficult to work through the armpit on the breast because of the distance.

The trans-umbilical breast augmentation (TUBA) incision is made in the belly button. An endoscope is inserted up to the breast and the implant pocket is formed behind the breast, either on top of or underneath the chest muscle.  The saline implant is folded and pushed through the channel up to the breasts. The breasts are filled with saline solution and the endoscope is removed. The scar that forms is quite small.  This type of incision may speed up the healing process. Milk ducts and nerves in the breast are uncut, so loss of sensation and breastfeeding problems do not occur. Only saline implants may be used with this incision because the silicone implants are prefilled. Breast asymmetry may occur because of the longer working distance. This incision may not be used when a breast lift accompanies the augmentation surgery. It is difficult to correct any defects such as capsular contracture with the TUBA incision. One very rare complication is a permanent track on the abdomen due to the movement of the endoscope beneath the skin.

Augmentation surgery takes place in Dr. Khalifeh’s accredited surgical center in Chevy Chase, Maryland under general or twilight sedation.  If the Sibley Memorial Hospital in Washington, D.C. is more convenient, Dr. Khalifeh holds privileges there as well.  Breast augmentation surgery lasts one to two hours and an overnight stay is not necessary. It is best to take at least three days off work. The recovery time is one week and stitches are removed at that time. Another two weeks are necessary before strenuous activity may be resumed. Possible but rare complications include bleeding, infection, implant rupture, capsular contracture and risks associated with anesthesia.

Call today to schedule a consultation with Dr. Khalifeh: (301) 244-0148.