March 2008
This month, Norman Waterhouse discusses -
Minimising your incisions and scars
To ask Norman Waterhouse a question, or to make a comment, please click the comment button below the blog entry. His response will appear here shortly.
For any woman considering breast enlargement, the obvious attraction is achieving a beautiful natural shape and a feeling of confidence in her body. As well as looking great in lingerie, a cocktail dress and a bikini, it is also important to be confident naked! This means that any scar resulting from surgery should be small, discrete and as “invisible” as possible.
No matter what technique is used, some form of scar is inevitable. The size, position and quality of the scar are determined by many different factors. There are a number of options available for placing the incision, including:
- The infra-mammary scar – The commonest technique, involving an incision at the base of the breast. The horizontal incision is usually about 5cm in length (Fig 1).
- The peri-areolar scar – This incision has become much more popular in recent years. It is contained within the lower half of the darker skin of the areola (the pink or brown circular area around the nipple) (Fig2)
- The axillary (armpit) scar – This approach places a scar in a natural crease in the skin within the armpit area. In most cases, the scar heals very well and has the obvious advantage of avoiding any scar on the breast. (Fig 3)
- The peri-umbilical (belly button) incision – A scar around the belly button for breast enlargement has mostly been used in the United States. It has the advantages of avoiding any scar on the breast but has some significant “downsides”.
What’s your best option?
Each of the above has advantages and disadvantages. Which one is best for you? Tell our Mybreast expert Norman Waterhouse about your size, skin type and the size of implants that you want, so he can help you decide. Would you like to share your concerns about scarring? Norman can tell you what to expect, and reassure you. He will post his response to your comment/question within 48 hours.
Come back for more discussions, including:
Peter Butler: Silicone. Is it safe?
Patrick Malucci. Implant choice: round or anatomical?
Martin Kelly. Your implants: above or below the muscle?
Simon Withey. The tuberous (“tubular”) breast
23 responses to Minimising your incisions and scars
- Susie says: March 17th, 2008 at 10:11 pm
Love the site, it really is the first time I’ve come across such a helpful website with good results and professional advice. Do you have a clinic in Liverpool? Best XXX S.
Reply to this comment - Samantha says: April 1st, 2008 at 6:59 am
What a helpful site - its answered all my questions. Mybreast will definately be my first port of call for surgery.
Reply to this comment - Jane says: April 1st, 2008 at 3:57 pm
I am worried about scarring. My caesarean sections both resulted in keloid scars. Even a mole removal shows a scar for each stitch. How could I be certain that I would not have “car crash” breasts?
Reply to this comment - Norman Waterhouse says: April 4th, 2008 at 8:55 am
@Jane: Dear Jane,
There is no doubt that if you have demonstrated a tendency to develop hypertrophic or keloid scars following previous surgery, then there is a risk of producing the same type of scars if you have breast augmentation surgery. There may be less chance if the scars are around the nipple or in the armpit. For people with a known tendency to form a bad scar, treatment can be administered to try and prevent or minimize the scar. This includes the use of steroid injections into the scar or the use of gels or creams containing silicone (see http://www.healgel.com)
Despite these options however, you would have to decide if you were prepared to accept a less than perfect scar as a trade off for breast enhancement. The degree of risk could better be assessed by a Mybreast surgeon at a consultation, as the degree of hypertrophy ( redness and lumpiness) varies from person to person and in different sites of the body.
Reply to this comment - Kiki says: April 14th, 2008 at 8:51 am
My skin has marks years after simple injuries as burns and scratches. Does that mean I will have longer and more visible scars after breast augmentation?
Reply to this comment - Linda Fuller says: April 19th, 2008 at 4:26 pm
I am 58 years old, and have just lately been considering breat implants. My size is normally 34B/C and I would only like to go up a cup size. They are also not as perky as they used to be! I have a small frame, size 10/12. Am I too old to consider having them done? I want them to look as natural as possible.
Reply to this comment - Norman Waterhouse says: May 19th, 2008 at 5:06 pm
@Kiki: It is important to clarify exactly what you mean when you say that your skin ‘marks’ after burns and scratches. Often, after minor injuries to the skin, you may be left with some changes in skin pigmentation. In other words, the area may be slightly darker or lighter than the surrounding skin. This is particularly true if you have Asian or Afro-Carribean skin tones. The scar from a breast augmentation will not be longer than normal but it is possible that the scar may be more visible as it could be darker or lighter than the skin around the breast. If you produce thick red raised scars from minor injuries, you may have a tendency to form hypertrophic scars. This may also occur after surgery. Perhaps you could email a digital photograph of the skin marks you describe? Alternatively, you could discuss this with a Mybreast surgeon who would be able to assess and advise you on the risk of scarring.
Reply to this comment - catherine naylor says: June 9th, 2008 at 3:44 pm
hi.
Im 18 years old and I and my sister, who is 20 years old are seriously considering having breast enlargements. Do you think we or I are too young due to still growing? Thank you xxx Reply to this comment - sharon Demmon says: July 8th, 2008 at 5:57 pm
What happens if your breasts encapsulate?
Reply to this comment - Norman Waterhouse says: July 17th, 2008 at 4:35 pm
@Linda Fuller: In theory, you can have a breast augmentation at any age provided you are medically fit and well. Often, older patients may have droopy breast or empty breasts. In these circumstances, a breast lift or mastopexy may be required. If there is little breast tissue and a lot of extra skin, breast enlargement surgery may result in a more ‘obvious’ look. A consultation with a Mybreast surgeon would be helpful in deciding if you are suitable for the procedure.
Reply to this comment - mybreast says: July 18th, 2008 at 12:50 pm
@sharon Demmon: There will be an expert forum later in the year devoted to the problem of capsules. Look out for this!
Reply to this comment - Dione says: July 29th, 2008 at 10:09 pm
I am diabetic insulin dependant and have been for 14 years. I am 21 and really want breast surgery but is it safe for a diabetics?
Reply to this comment - jacqui says: August 9th, 2008 at 4:38 pm
I had a breast augmentation when I was in my early 30’s and had silicone implants. Then I was advised by the surgeon to replace the silicone implants with gel ones, but after the op I needed correction a few weeks later as they were un even and I couldnt cope with that so a larger implnat was put in one side . Then the trilucent company advised evrybody who had these implants to have them removed immediatey for health reasons, so I had to ( yet again!!) and again I had problems with unlevelness and uneveness, so had to go back in a short time after to sort it out. All was good in the end but I had to have 5 ops. The original scar was used each time . ( this has all spanned approx 16 years) but now the breast on the side that he had to use a larger implant in, seems to have got bigger on it’s own as I age and I hate the size being un equal. One breast fills out my bra more than the other and I notice it in clothes, they pull slightly to the bigger side. Also, the scar is very noticeable and is very indented. From the side view it is really noticeable as the original scar from the very first op, was in the crease, under the breast but as I had them bigger, the scar has moved up and is very visible. I have spoken to the surgeon about this and we seriously consider another op, to equal out the size and reduce the scar but I would really welcome another opinion on this, I hate the scars ( not because I have them as thats inevitable, but because they are so visible) and I really struggle with the uneveness in size. I went from an original 34A to a 34 B/C, then to a 36 D, then DD. As I have aged, ( I am 47) I have put on a bit of weight and I had breast fed 3 children before my ops and had two more and fed them both, after the original op, which is why I opted to go bigger, to fill up the skin.
Realistically, can anything be done to reduce the scarring?
Can I expect to have both breast the same size?
I do love the natural shape and amazingly, my breast shape is good. Can I retain that? Reply to this comment - heidi banks says: August 13th, 2008 at 12:24 pm
can an implant be placed under the muscle when having a nipple insertion?
Reply to this comment - kathryn says: September 2nd, 2008 at 12:00 pm
Is there anything i can do b4 surgery to help prevent stretch marks or help scaring.
Reply to this comment - Angie O'Keeffe says: September 5th, 2008 at 6:21 pm
I am 40 yrs old, had 375cc teardrop implants 8 years ago, i feel they have dropped and would like a breast lift and implants replaced….is it poss to go smaller in size or would there be excess skin? if i have a “low breast line” would i not be able to acheive a higher perkier look?
Reply to this comment - normanw says: October 21st, 2008 at 5:35 pm
@kathryn: Keep the skin moisturised and use HEAL gel after surgery
Reply to this comment - normanw says: October 21st, 2008 at 5:38 pm
@jacqui: I advice you to be seen by one of Mybreast founding surgeons for 2nd opinion. The case is too complicated to be answered without seeing you.
Reply to this comment - normanw says: October 21st, 2008 at 5:40 pm
@Dione: Yes it is possible to have breast surgery, but diabetic control must be good and the operation needs to be planned with Mybreast surgeon and anaesthetist
Reply to this comment - normanw says: October 21st, 2008 at 5:43 pm
@Angie O’Keeffe: Yes it is possible to go smaller in size and to achive perkier look regardless the low breast line
Reply to this comment - normanw says: October 21st, 2008 at 5:45 pm
@heidi banks: Yes it is possible to have the implant under the muscle with a nipple insertion as long as the nipple and areola are not very small
Reply to this comment - Sam Little says: November 7th, 2008 at 12:17 am
I had a breast augmentation 4 months ago and I have double bubble (the implant has dropped considerably). A lift was/is not indicated. I have been told I could either have teardrop implants (I currently have rounds) and/or dual plane to fix it?? Should I get a second opinion or let the first surgeon sort it out? Do mybreast ‘fix’ problems from BAs performed by other surgeons? If yes who would you recommend I see?
Reply to this comment - Sam Little says: November 7th, 2008 at 12:24 am
I forgot to ask also whether the scarring is much worse after a 2nd BA. If the incision was made in the wrong place will I have to have a 2nd incision?
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