Breast Augmentation Options Charleston


There are four possible incisions for placement of breast implants. The two most common are the inframammary crease incision (an incision along the bottom of the breast) and the peri-areolar incision (an incision along the lower half of the areola). Placement is possible through an incision in the axilla (armpit) as well is the umbilicus (belly button). However, these areas are less frequently used and, particularly in the case of the umbilical approach, results are much less consistently acceptable.

Dr. Terranova recommends the peri-areola incision to most of his Charleston breast augmentation patients. He feels that the scar is of much higher quality in this location than in the area of the inframammary crease where the weight of the implant often causes the scar to widen or even become hypertrophic (raised and hyperpigmented). He also feels that it is easier to get a consistently excellent result, particularly when considering the inferior sweep of the implant pocket, from this approach. Finally, Dr. Terranova likes the fact that the peri-areola access allows the outside to be further away from the implant.

Most of Dr. Terranova’s patients who are referred by former patients have seen the scar that results from this incision and come to the consultation specifically asking for this approach. Other patients may be concerned about nipple sensation. Nipple sensation can be affected by breast augmentation but the effects are due to the physical placement of the implant (the nerves emerge from between the ribs near the outside of the breast and have to be stretched to accommodate the implant) not to the location of incision. The peri-areola incision also has no effect on nursing.

Breast Implant placement

There are two options for implant placement. The first, and perhaps most intuitive, is placement immediately under the breast and on top of the chest wall muscles (the pectoralis major muscles). This was the placement for decades when breast implantation was first popularized. This is called the sub-glandular position. The second option is to place the implant underneath the chest wall muscles. This is called the sub-muscular position.

There is less controversy amongst plastic surgeons than there used to be about which placement is the best. Most of plastic surgeons place their implants in the sub-muscular location. However, Charleston breast augmentation surgeon Dr. Terranova still believes there are occasional patients for whom sub-glandular placement is preferred.

The major reason for sub-muscular placement is avoidance of capsular contracture. Every patient has a capsule around the breast implant. This capsule (one membrane) is laid down by the body to separate itself from the implant which is a foreign material. In most cases the capsule does not affect the way the implant response to gravity and therefore the result appears to be natural. But in some cases the capsule thickens and begins squeezing the implant very much like two hands squeezing a water balloon. The breast then looks too round, the implant looks too high, and the breast is too firm. Essentially the result looks fake.

We do not know the cause of capsular contracture and therefore we do not know how to prevent it. However we have found that placing the breast implant in the sub-muscular position lessens the number of cases that we see.


There are some downsides of the sub-muscular position. Recovery is more painful for the first couple of days, but that is certainly not a reason to avoid submuscular placement if the odds of a better aesthetic result are improved.

What can be, for some patients, more problematic however is what occurs when the pectoralis muscle is contracted. In that case, the muscle contraction moves the implant upward and the breast moves along with the implant. This can be particularly noticeable depending upon the situation. Some women’s occupations or avocations require heavy use of chest wall muscles, including masseuses, chiropractors, paramedics, and bodybuilders. In these women we most often place the implant in the sub-glandular position to avoid constant breast motion.

In addition to unsightly breast motion that can sometimes occur with sub-muscular placement, continued muscle contraction moving the implant upward and outward can, over months or years, sometimes displace the implant from its appropriate position causing it to move toward the axilla (armpit). So patients who work out consistently and do not wish to forgo specific upper body exercises are sometimes served better by sub-glandular placement as well.

Finally, there are occasional anatomical problems (severely deflated breast, tuberous breast) in which a better aesthetic result might be achieved by sub-glandular implant placement.

During your consultation, the issues of incision placement and implant placement will be discussed at length so that you can make the appropriate decision of which option is right for you.

If you are interested in finding out more about your breast augmentation options and are in the Charleston, Mt. Pleasant, or Summerville, South Carolina area, please contact William Terranova, MD today.