When performing breast augmentation, surgeons will generally use one of four techniques.

The Four Basic Techniques of Breast Augmentation Surgery


According to the American Society of Plastic Surgeons, breast augmentation remains the most frequently performed cosmetic surgical technique in the U.S. Of the approximately 1.8 million such procedures conducted in 2016, breast augmentation was at the top of the list with 290,467 operations done, a 4 percent increase from 2015 (liposuction was second with 235,236 procedures).

As these thousands of procedures are done, surgeons generally employ one of four techniques. They approach the decision on which technique to utilize based on the patient’s anatomy and expected outcome, as well as the method and surgical retractor that will leave the least visible scar.

The four techniques
The American Board of Cosmetic Surgery lists these four primary breast augmentation techniques:

Inframammary: In this procedure, a small incision is made in the fold underneath the breast (called the inframammary fold). The advantages of this technique is that the incision allows the surgeon to have a wider access point to insert the implant with greater precision. In addition, the remaining scar (generally about 1 to 2 inches long) can be concealed under the crease.

Peri-areolar: This procedure requires an incision to be made near the outer edge of the areola. In this manner, the scar is somewhat hidden by the natural pigmentation progression of the areola and the rest of the breast. This is the preferred technique for cosmetic surgeons to use if they are also performing a small to moderate breast lift during the same procedure.

Trans-axillary: A small incision is made under the armpit. The breast implant will be inserted in this opening by the surgeon using special surgical instruments and a camera to ensure proper placement. The procedure does leave a small scar at the point of incision but the breast itself remains scar-free.

Transumbilical: An incision is made above the navel and the implants are inserted through this incision and then moved up to the breast. The transumbilical technique leaves a single small scar and no scars on the breasts themselves.

A call for standardization
Currently there is no standard breast augmentation technique, despite a call by some surgeons to standardize the procedure by using best practices. In a study published in the Aesthetic Surgery Journal, the authors released the results of their survey that found techniques and post-surgery treatments vary around the world.

“There exists accordance regarding several aspects of breast augmentation surgery, however international practice patterns remain very incoherent,” the surgeons wrote. “While distinct techniques can already be advocated independent of location, plastic surgeons may still benefit from internationally applicable high-level studies in order to create standardized evidence-based practice guidelines and further improve outcomes”

Dr. Carlos Rubi Ona, a surgeon in Valencia, Spain who was not involved in the study, told Reuters that breast augmentation surgical techniques face the same complications as any other procedure.

“Aesthetic surgery is a cosmetic procedure, but we should not forget that it carries the same risk of complications, if not even more, as many other non-aesthetic procedures,” Ona said.

With such a disparity in breast implant techniques, the risk of surgical site infections from an improperly cleaned reusable tool is ever-present. In addition, purchasing and maintaining reusable and semi-disposable retractors and light sources can represent a significant expenditure.

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