Breast augmentation and choice of incision

With every breast augmentation patient in Santa Barbara, I go over the various types of breast implants, the various pockets that breast implants can be placed in, and additionally the different incisions that can be used to place the breast implant into the breast pocket. With respect to this last issue, I think there is some helpful information that has recently been published.

Firstly, we need to discuss infection and capsular contracture. Capsular contracture is a situation where the tissue around the breast implant, called the capsule, begins to thicken and contract around the implant. This is a problem with a long history- it was not an uncommon problem with early breast implants before more recent versions (the types of breast implants we currently use) came about. When breast implants used to be placed in front of the muscle, capsular contracture was particularly common in breast augmentation. Today, plastic surgeons like me do everything we can to reduce the rate of capsular contracture, and I’m pleased that the rate of this problem is quite low in my breast augmentation patients.

One reason, I think, has to do with my preferred incision placement. While I will use both the peri-areolar incision (around the nipple) as well as the inframammary incision (underneath the breast), I am tending towards the inframammary incision because of a recent study that Dr. TC Wiener published in Aesthetic Plastic Surgery called “Relationship of incision choice to capsular contracture”. This study found a significantly lower incidence of capsular contracture with the inframammary incision than the peri-arolar incision. Why is this? While nobody is quite certain, we think it may be due to the fact that peri-areolar incisions require the milk ducts to be cut, while the inframammary incision allows dissection completely underneath the breast tissue. Surprisingly, the milk ducts harbor low levels of bacteria, similar to your skin. We think that the breast implants may get inoculated with these low levels of bacteria when performing breast augmentation through the peri-areolar incision, and that this low level of infection may initiate the process of capsular contracture.

In my Santa Barbara plastic surgery practice, I do everything I can think of so that my breast augmentation patients have minimal infection and capsular contracture problems. In the operating room, antibiotics are given through the IV. Breast implants are bathed in antibiotic solution before they are implanted, and the pockets that receive the breast implants are also irrigated with antibiotic solution before and after breast implant placement. Fresh, new gloves are used when each breast implant is handled. Sterile towels, soaked in antibiotic, are used to help deliver the breast implants to the incision so they can be placed into the pocket with as much defense as possible against any infection. Of course, all of my patients are also given antibiotics after surgery as well.

I am happy to perform a peri-areolar incision in patients who wish this, as long as they are well informed, though I feel that using the inframammary incision is yet another way that my breast augmentation patients in Santa Barbara can be protected against infection. I’m proud that I have never had a patient who had a breast implant infection. I’m doing everything I can to keep my patients as safe and as happy as possible.

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