Posted February 04, 2025 in Breast Augmentation
9 Min Read:
Breast augmentation is one of the most popular cosmetic surgeries. David Stephens, MD Plastic Surgery | Aesthetics is one of the busiest and sought-after cosmetic surgery practices in the Seattle metropolitan region, and we pride ourselves in taking care of women in our diverse international community. We truly enjoy serving all of our patients and fostering our relationships with them, and we seek out techniques and treatments to achieve the best results found in any of the world’s metropolitan areas. Here we discuss how to optimize scar management with breast augmentation in all of our patients.
Women of all skin types will have a scar from the incision as the tradeoff when undergoing breast augmentation surgery. However, for women with more melanated skin, there is a greater chance of forming a post-inflammatory-hyperpigmented (PIH) scar and possibly a raised hypertrophic scar. We know that darker skin has a higher risk of developing thicker scars or keloids, which is when the hard scar grows outside of the incision site area. We encourage our patients to discuss their history of scar formation and family history of severe scars and keloids.
Choosing the Breast Augmentation Incision Type
Breast augmentation is a cosmetic enhancement, so being left with an obvious scar is not ideal, to say the least, especially when you want discreet results. Many women are now looking for more naturally shaped and proportionate breasts. So, the scar should be made as inconspicuous as possible. Choosing the right incision site so it is placed in a hidden, inconspicuous area is key: either discreetly under the breast fold, around the lower half of the areola (the dark skin around the nipple), or completely off the breast in the armpit using an endoscope (the TEAM Procedure) are the most ideal locations for the incision.
Incision sites may seem like a decision for your surgeon to make based on a number of factors. But if you are concerned with scarring, we will discuss these scar placement options and tradeoffs during your consultation. Certain incision sites are located on or around the breast, so if you are worried about battling scars around your breasts, these might not be the best option for you.
Transaxillary Incision:
This incision site is located in the high hidden area of the armpit, called the “hidden incision.” With this technique, your incision will be placed within the armpit instead of the lower breast fold or around the areola. Therefore, there will be no visible scarring on or around the breasts.
Dr. David Stephens is one of the leaders who developed the endoscopic (TEAM) approach to implant placement many years ago. Dr. Stephens has performed thousands of successful breast augmentation surgeries using this method, so you can feel confident that your scarring and ultimate results will be beautiful.
During the transaxillary placement, Dr. Stephens will place an endoscope through the incision in the armpit, allowing him to make a precise dissection and creation of the breast implant pocket.
One of the common drawbacks of a transaxillary placement is that most surgeons only use a saline breast implant, as these are filled after placement into the breast pocket. However, Dr. Stephens is highly experienced with the endoscopic transaxillary incision (TEAM) technique and is one of the few surgeons in the country who can place both saline and silicone breast implants — allowing for greater freedom for the patient in selecting implant size and profile. However, larger implants or breast shape considerations may limit the ability to use this approach.
Additional Incision Placement Options:
Inframammary Incision: The incision is placed in the crease where the breast meets the chest wall. The advantage of this incision is that studies show that there is a lower risk of capsular contracture, which is when thickened scar tissue forms around the implant and makes for a hard, malpositioned, and misshapen breast. Dr. Stephens uses a Keller Funnel® and a very specific preparation process prior to breast implant surgery that has been shown to minimize the risk of capsular contracture.
Periareolar Incision: This incision is made around the nipple-areolar complex. This is often a good choice for Asian women and women who have darker skin tones where prolonged pigmentation or increased scarring is a concern, as the scar pigmentation blends nicely into the areola pigmentation.
Your decision for incision placement is based on your overall goals for breast augmentation and your potential for significant scarring or prolonged pigmentation. Incision choice should also consider the different rates of capsular contracture based on the incision location.
The Procedure
An important part of minimizing scarring is the technique that your surgeon uses. Dr. Stephens was one of the first surgeons in the northwest to utilize The Keller Funnel®, a device that reduces the risk of infection and capsular contracture, which also allows for using smaller incisions. Additionally, the suturing technique your surgeon does plays a huge role in how your body heals after breast augmentation surgery. A cavalier, inexperienced, or unskilled surgeon may use clumsy or imprecise suturing, resulting in larger scars. It is important to choose a surgeon with the skill to make precise and carefully placed incisions and strategic methods of closure for optimum healing.
About Scars
The severity of the thickness or the increased amount of pigmentation of the scar depends on several factors including the precision of the surgical closure, your natural healing ability, the tension on the incision, the aftercare, and most of all, the genetic predisposition to make either thicker, darker scars or thin, less conspicuous scars.
As a group, women of color and other races can be predisposed to thicker scars and may develop thicker and/or darker scars, including: African American, African, Asian, South Asian, Middle Eastern, American Indian, and some Hispanic women. There is a predetermined genetic-based, scar-forming propensity to make thicker, darker scars. Those with pigmented skin have a greater chance of experiencing darker or raised scars or even keloids. Interestingly, a different type of hypertrophic scar may occur in very fair-skinned individuals who may have a higher risk of unpigmented, very red hypertrophic scars due to the poor collagen in their skin.
Why darker scars?
Increased melanin is produced adjacent to the incision because of the trauma and tension that creates inflammation, which stimulates melanin production. Generally, if there is more existing melanin, then more melanin is produced. This reaction is called post-inflammatory hyperpigmentation (PIH), which makes scars darker and can take time to fade. Melanin protects the skin from UV damage. Much like the darker skin of the suntan that we get after the inflammation from a sunburn, the inflammation from the incision creates a darker scar. When the injury heals, the body continues to overproduce melanin. This may continue to stimulate the production of scar tissue, resulting in darker and raised scars. In those with darker skin, there may be a longer production of pigment.
Because of the prevalence of concerns of scarring in women of color or those more prone to thicker scars, some may be wary of undergoing breast augmentation surgery for fear of dark or unsightly scars. However, you shouldn’t hold off on your decision to undergo a procedure that can bring you self-confidence and satisfaction with your body.
The Best Way to Treat Breast Augmentation Scarring for At-Risk Patients Is Prevention!
Scars are the result of any surgery, but with the skill and advanced technique of your surgeon and good scar care, yours should be minimal.
At David Stephens, MD Plastic Surgery | Aesthetics, we recommend certain products for patients more prone to prominent, darker scarring even before surgery in order to minimize scars and hyperpigmentation. Following your surgery, we recommend scar treatments including BIOCORNEUM®, an FDA-approved silicone-based scar treatment gel with sunscreen to minimize scars and keep scars flat and contained while healing. It is a good idea to wear medical-grade sunscreen daily to protect against hyperpigmentation over the surgical area. Serial steroid injections may be used for more stubborn scars.
For persistent darker or thicker scars there are in-office aesthetic treatments that help to improve scarring and hyperpigmentation. This may include serial steroids or other types of injections. Skin resurfacing treatments like the MicroLaserPeel® or the Sciton BBL treatments can successfully reduce the appearance of scars. In fact, these treatments and other laser-based treatments have been a huge development in managing severe, third-degree burn scars.
Dr. Stephens may recommend a scar revision treatment plan to enhance the cosmetic results of the surgery. We have the most recent state-of-the-art procedure protocols and devices in the aesthetics arena.
Choose an Experienced Breast Augmentation Specialist
As an experienced breast surgeon, Dr. David Stephens has been perfecting and improving breast augmentation procedures for decades, utilizing innovative techniques and the best technology, as well as holistic practices to optimize outcomes in his patients. We have designed a programmed, “rapid recovery” protocol to speed you back to an active life as comfortably as possible.
A view of Dr. Stephens’ before and after gallery speaks to his level of care and success with breast augmentation procedures.
Why trust your breast augmentation procedure to Dr. Stephens?
For one thing, he was voted by his patients as the “Top Cosmetic Surgeon” in 425 Magazine, covering the Eastside for nine years in a row!
Dr. Stephens is dedicated to helping his patients with state-of-the-art technologies, advanced surgical techniques, and open dialogue. He is certified by the American Board of Plastic Surgery and has the experience to deliver the results his patients desire. In addition, Dr. Stephens’ office staff has received continuous kudos from our patients. For this reason, David Stephens, MD Plastic Surgery | Aesthetics has been voted the “Best 425 Magazine Cosmetic Doctor” for nine years in a row in 2024 and perennially the Puget Sound Top Plastic Surgeon in KING 5! From the initial consultation to an innovative and comprehensive recovery program, your needs, goals, and desires are his top priorities.
Interested in Learning More About Breast Augmentation in Bellevue, WA?
If you are interested in your options for a successful breast augmentation procedure with Dr. Stephens in the Seattle area, call our office today at (425) 455-0444 or fill out our online contact form to schedule a consultation.
