What about Scars?

We’ve said it once, and we’ll say it again. No scar location is necessarily always better than another. Let’s examine some myths about scars:


Myth 1


For patients with minimal or no breast tissue, a scar under the breast isn’t a good choice.


Not necessarily. If the scar is properly positioned exactly in or very slightly above the crease beneath the breast, it will be minimally noticeable.


We’ve heard from more than one patient, "My boyfriend (a medical student on a medical fact finding mission, I’m sure ) said that he saw a scar on a topless dancer that was up on the breast, and it was terrible.


I don’t want that incision." The facts? Topless dancers have more inframammary incisions than any other incision. The reason the scar was more noticeable was that it was improperly located. If the scar is placed too high above the fold, it’s in an area where it is maximally stretched by the pressure of the implant. If it were kept exactly in the fold or very slightly above the fold, there’s less stretch, and the scar would be narrower. A popular misconception I’ve heard from surgeons is that inframammary scars should be placed well above the fold "so that it won’t show when she raises her arms in a bikini." Fact is, less than 1 percent of a woman’s life is spent in a bikini. Fact is, a good scar exactly in the fold is far better than a widened scar that occurred because it was placed too far above the fold. If a surgeon is experienced in all incision locations, you can just choose! If you don’t like one (incision or surgeon), choose another!


Myth 2


One incision location is less noticeable than another.


Not true. It depends on the patient’s body position, who is looking, how long after the surgery (whether the scar is mature and faded), and the quality of the scar (largely dependent on each patient’s healing tendencies). What is always less noticeable is a better quality scar, regardless of its location.


Myth 3


A shorter scar is always better than a longer scar.


Not true. The quality of a scar is much more important than its length.


A short, ugly scar is always more noticeable than a slightly longer, thin, faded scar. Experience has taught many surgeons that when you make an incision too short to minimize scar length, you often stretch that incision and "traumatize" the incision edges excessively during surgery. The scar does not heal as well, often stays redder longer and becomes wider. The result is a shorter scar, but also an uglier scar. A better quality scar, even if it is slightly longer, is far better than a short, ugly scar.


Myth 4


If you can put the incision off the breast in the armpit or the belly button, it’s always better.


Not true. We’ll cover specific advantages and trade-offs of each incision location later in this chapter, but there are definite trade-offs for both the axillary (armpit) and umbilical (belly button) approaches that may not appeal to some patients. Fact is, after surgery, scar location usually becomes a nonissue if the patient has an excellent result.


Myth 5


One scar location or another always preserves breast sensation better.


Not true. We formerly believed the axillary (armpit) incision preserved sensation better than other approaches, but after many more years’ experience, we don’t think that is necessarily true. The factors that most affect sensation are 1) surgical technique—the more the surgeon directly visualizes the anatomy and the less bleeding, the less risk of nerve compromise, and 2) the size of the implant—the larger the implant, the larger the pocket required, the more nerves are likely to be cut, and the more stretch the implant places on nerves; hence, the greater the chance you’ll lose more sensation.


Myth 6


Surgeons pick scar locations because they think one is best.


Not necessarily true. Surgeons usually pick scar locations based on their experience. If they have a lot of experience with different scar locations, they’ll offer you all options and discuss the trade-offs. If they’ve only done breast augmentations one way (or even the majority one way), that’s the scar location they will most likely suggest.