There are a variety of breast implant insertion techniques and positions for the incisions. Most surgeons have a preferred technique and location of the incision because of training and experience with that method.
Breast implants are inserted into the patient’s breasts through small incisions located on or near the breasts. The most common sites for the incisions are in the crease underneath the breast, around the bottom edge of the areola and through the armpit (axilla). Although trans-umbilical placement of implants is also been described, it is mentioned only to be condemned for a variety of reasons including voiding of warranties for the implants by the manufacturers.
These incisions are generally about 1.5 to 2 inches in length for saline implants and around 30% to 40% longer for silicone gel implants. This is primarily because saline breast implants are filled with air, which is taken out prior to insertion. This capability allows the surgeon to flatten the implant and roll it up so that it can fit through a smaller opening than if it was completely filled to size. Following such an insertion, the saline breast implant is inflated through a small fill tube until it reaches the desired volume while it is in the pocket.
On the other hand, silicone gel breast implants are pre-filled and their size cannot be adjusted to accommodate a smaller incision. Hence, silicone implants need to be pushed in through an opening which requires a
much longer incision. The length of the incision primarily depends on the size of the implant that the patient has opted for: the larger the chosen implant, the longer the incision.
After the incision is made, a tunnel is then created, reaching up to the desired position of the breast implant pocket, which is either on top of or underneath the chest (pectoralis major) muscle. Placement of the implants underneath the muscle is strongly recommended to reduce implant palpability, visibility, rippling and capsular contracture. Once an adequate sized pocket is created, the appropriate breast implant is slid in through the tunnel into the pocket and positioned with care. While insertion sleeves exist for implant insertion designed to potentially reduce contamination of implants during the insertion process, they are rather expensive and have not been proved to be effective.
After checking for proper placement of the implants and symmetry, the surgeon closes the earlier created tunnel with several layers of sutures. Dr. McMahan prefers a three layered closure with the first two being absorbable sutures and with the final layer, a polypropylene pullout suture is used to reduce scarring and to facility easy stitch removal. Surgical tapes are then used to cover the incision for further protection and to reduce scarring as well followed by a sterile dressing.
Following a breast augmentation procedure, patients can expect to go back to work after a week’s time, given that their work does not entail heavy lifting and strenuous tasks.