Breast Augmentation Techniques
Many women are unaware of the variety of different techniques available from an experienced, board-certified plastic surgeon performing breast augmentation. In the Phoenix-Scottsdale, AZ area, Dr. Robert Cohen specializes in innovative yet proven techniques – one of the many reasons women seek him out for procedures such as breast enlargement.
Request a cosmetic consultation with Dr. Cohen and learn what sets him apart as one of the country's leading breast enhancement surgeons.
Dr. Robert Cohen: Board Certified by the American Board of Plastic Surgery
For your breast enhancement procedure, you deserve a specialist with years of experience and dedicated focus on his patients' results.
Breast Augmentation Techniques from Dr. Cohen
When I see women for breast implants in the Scottsdale-Phoenix area, I always view each surgery and each patient as completely unique. This allows me to evaluate the patient's anatomy and her goals and to develop a truly customized approach to her surgery. Through years of experience and some of the best training available, I am able to determine the ideal surgical techniques for achieving natural, beautiful results for my patients.
I am honest with my patients and let them know which techniques I believe will provide the best outcome. In addition to recommending an implant type, I make recommendations regarding the placement of the implant and the type of incision that will achieve the most aesthetic result.
I almost always place the breast implant underneath the pectoralis (chest) muscle. This requires more surgical skill, time and effort, but offers numerous advantages. This approach provides more padding and soft tissue coverage, making the outline of the implant less visible and the result more natural looking. It also reduces the appearance of wrinkling or rippling, particularly in patients with thin skin or minimal breast tissue.
Submuscular placement is also shown to have a reduced rate of capsular contracture, a complication in which scar tissue hardens and tightens around the implant, distorting the look or feel of the breast. This is also the preferred placement for mammography screening, since the implant is behind the breast tissue.
Incision Type (Location)
Incisions for breast implant placement are most commonly made around the areola (periareolar), along the breast fold (inframammary), through the armpit (transaxillary), and through the bellybutton (transumbilical). I prefer to use the periareolar incision or the inframammary incision for several reasons.
One of the key factors to a symmetrical, natural looking result is the meticulous and accurate creation of the breast pocket – the space the surgeon makes to hold the implant. The transaxillary and transumbilical approaches create the breast pocket from a remote incision using long instruments. I believe directly accessing the interior of the breast and using my own hands to create the breast pocket improves accuracy and the quality of results. Furthermore, the scars from transaxillary breast augmentation are sometimes visible in the armpits, and transumbilical breast augmentation can only be performed using saline breast implants. The transaxillary approach also has a highest rate of capsular contracture.
In many cases, I use a periareolar approach, which places a fine incision halfway around the lower or upper border of the areola (the area of more darkly pigmented skin around the nipple). It is well camouflaged, the skin here tends to heal with a fine scar, and the incision is always concealed in a bra or a bathing suit. I feel that access through the areola provides me excellent control in shaping the lower breast curve. An upper areolar incision also allows me to lift the areola position with a crescent lift (small removal of skin above the areola) to correct asymmetry in patients where one areola is lower than the other. Both areolas can be raised in the same fashion if they both start out in a lower than ideal position.
It is important to note that the nipple and areola stay completely attached to the breast with this technique, and there is no significant increase in the risk of nipple sensation loss with a periareolar incision compared to other approaches. In rare instances, when a woman's areolas are very small, a periareolar incision is not an option and I will use the inframammary (lower breast crease) incision.
One disadvantage to the areolar approach is that some tunneling through breast tissue must be performed to reach the chest muscle. This may have a potential impact on breast feeding, although the majority of my patients who had children after breast implants via an areolar incision were able to breastfeed. There is also a higher risk of capsular contracture with an areolar approach than there is with an inframammary incision (approximately 4-5% chance with an areolar approach versus a 1-2% chance with an inframammary approach in my personal experience).
Because of these issues, I try to balance aesthetic needs with risks. If a patient has fairly symmetrical and proportionate breasts, or larger breasts with dense breast tissue, I am more likely to recommend an inframammary approach. If patients have significant asymmetry or low nipples, I will generally recommend an upper areolar approach.
Occasionally a patient will have a strong preference for a particular technique which may not be to her best advantage. I always take the time to listen to her goals and understand her concerns. My diverse background and experience allows me to create beautiful results with a variety of techniques, and I will work with each patient to determine the best approach to her breast augmentation. Ultimately, we share the same goal, which is to achieve a balanced result that makes her feel beautiful and confident. For answers to common questions about breast augmentation, visit my frequently asked questions (FAQs) page.