Answers
"I am very interested in getting breast implants, but I can't find any doctors in my area that perform the surgery via transumbilical or auxiliary incision. Every doctor's office that I have called says that it is too difficult to do and that the warranty on the implant is void when doing these incisions. After reading another question on this site, I see that the warranty is NOT void. Why are so many doctors hesitant to do the TUBA and auxiliary incisions? I would think it would become more popular due to the scar locations. I don’t want to have scarring underneath the mammary fold and around the nipple."
— Answered by
Alan M. Engler, MD
New York, NY
You have raised a number of important issues.
First, if you contact ASAPS at surgery.org you may be able to find a surgeon who uses the incisions you are interested in. ASAPS is one of the primary resources for board-certified plastic surgeons who have a particular interest and focus in aesthetic surgery.
The umbilical (TUBA) and axillary incisions are inherently slightly more difficult (as compared with the periareolar and inframammary incisions) in the sense that the incisions are located farther away from the surgical fields. As such, slightly different instruments may be required and, as you are finding, more surgeons are probably reluctant to use those incisions.
But there are other issues. TUBA can only be used for saline implants and many patients currently prefer the silicone gel implants. A longer incision is required for a silicone gel implant than for a saline implant of the same size. That is because saline implants come empty, are inserted that way and then are filled once they are in place. Those characteristics are mandatory for TUBA, which is performed by pushing the empty implant through a tube and into the correct position. A similar concern has been raised for the axillary (or trans-axillary) incision. Again, the length of the incision is limited, and that may make it more difficult to use a silicone gel implant. Your desire not to have scarring in potentially more visible locations is understandable but there are practical considerations to the surgery that can, at times, override those concerns.
So, in summary - if you want a silicone gel implant, the periareolar and inframammary incisions are, in fact, the most appropriate choices, though a trans-axillary incision can occasionally be used. For saline, all four are theoretical options, though the two you mentioned do seem to be generally less popular. I hope this helps, and good luck.
