“augmentation mammaplasty”. The primary indication for augmentation mammaplasty is inadequate volume of the breast, which may be either developmental or involutional. Augmentation also may be performed for psychological reasons, including feelings of inadequacy, low esteem, lack of self-confidence, and sexual inhibition. Three incisions are most often used for augmentation mammaplasty. The periareolar incision is a semicircular incision at the border of the nipple-areolar complex. The inframammary incision is located at the inframammary fold; it does not extend medially beyond the medial border of the nipple-areolar complex.
The axillary incision is located in the hair-bearing region of the axilla. Recently the endoscope been used via the axillary or umbilical incisions, but this technique is not universally performed. Each of these approaches has benefits and drawbacks. With the periareolar incision, scarring is usually minimal, but there may be an increased incidence of nipple paresthesia. The inframammary incision offers excellent exposure but may result in a more noticeable scar. The axillary incision leaves no scar on the breast but may provide decreased exposure of the operative field. The implant may be subglandular, submuscular, or subpectoral. Every surgeon believes that his or her technique is the best, and to some extent this is true.
Still a few caveats should be remembered. Ptosis may be better addressed with either a subgladular or subpectoral placement. The implant is generally more camouflaged with submuscular or subpectoral placement. Regardless of the technique, the surgeon should listen to what the patient desires; in turn, the patient deserves to be well informed about the possible limitations of the procedure. Multiple studies have failed to show any increased induction or increased incidence of breast cancer in augmented patients with silicone gel implants.