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Armpit Incision for Breast Augmentation Because Nipples Are Small?

What is recommended going through the armpit or the nipple for a 350cc silicone implant? I have very small nipples that are very round and on the darker side. please let me know the pros and cons.

The Dr. recommended the armpit because my nipples are small. I am concerned about the scar size on my armpit and I am worried that it will be visible. I don't want to have to worry about these scars showing in the summer time. please let me know your opinions. Photo attached.

Doctor Answers (92)

Breast Implant Incision Under Breast Best for Silicone Gel Implants


Thank you for your question.

As you can see from the posted answers opinions vary greatly.

The most important issue is choosing an experienced, Board Certified Plastic Surgeon who does a lot of Breast Augmentation and follow his/her advice.

Generally, Silicone Implants require a larger incision which is easlily accomplished through an Infra-mammary Incison underneath the breast in the Infra-mammary Fold.

In my experience, the need for pocket revision or a secondary procedure is more common following an "arm pit" incision, because this is a "blind procedure"-the surgeon cannot see the pocket he is planning to place the Implant into.

The incision underneath the breast provides excellent visibility for the surgeon and will not be noticeable after surgery.

Web reference:

Boston Plastic Surgeon
5.0 out of 5 stars 24 reviews

Incision location for breast augmentation


With 350 cc implants, I would opt for an infra-mammary incision (within the crease of your breast). Every surgeon has his or her own preference, but placing such large silicone implants through the armpit and nipple can be quite challenging, and in some cases there is a risk of damaging the implant. If your surgeon has a lot of experience with the armpit incision, he or she should be able to show photos of other women's scars. This will allow you to choose the best approach for your surgery. Good luck, /nsn.

New York Plastic Surgeon
4.0 out of 5 stars 5 reviews

Armpit incision very dependent on surgeon experience


You will have scars for the rest of your life whatever your choice of incision. You need to decide where you want your scars based on your favorite activities and clothing. You do not want armpit scars if your hobby is ballroom dancing. You may not wish prominent breast scars if you like going topless.

I do a great number of transaxillary (armpit) breast augmentations and do not agree that the final shape is any different than an augmentation through a breast incision.

Placement of a 350cc silicone gel implant through an armpit is very straightforward and will not produce a longer scar than the one needed to go through an inframammary approach.

Vancouver Plastic Surgeon
5.0 out of 5 stars 34 reviews

Best incision for Breast Augmentation


Hi there-

I personally would not recommend the armpit incision to you- especially because of your concerns...

With an incision under your breast, you can expect it to remain hidden from view unless you are hiding nothing from view....

Armpit scars are NOT invisible, and the fact that you will have one on each side of your body just makes them even more conspicuous and attention grabbing. Furthermore, I do not believe that most experienced and skilled surgeons would agree that the shape of the breast is as reliably lovely as with the incision under the breast.

Having a cute scar under your arm won't make you happy if your breasts are funny looking.

Web reference:

Orlando Plastic Surgeon
4.5 out of 5 stars 82 reviews

Incision options with small areola


Hi Kinzie,


There are several things to consider when deciding on which incision you use to perform your surgery.  Cosmesis and the resulting scar are certainly an important consideration.  Another consideration is the risk for capsular contracture.  When a foreign body is placed in the body, the body reacts by forming a capsule of tissue around the foreign body.  In the case of breast implants, this capsule can be soft or it can become hard and even painful.  They can even distort the implant and result in poor cosmesis.  This is termed a capsular contracture, and the rates of these can be quite high, depending on implant choices and incision type.


Recent evidence seems to indicate that there are higher rates of capsular contracture with peri-areolar (nipple) and trans-axillary (armpit) incisions.  Using an incision in the fold under your breasts (IMF incision or inframammary fold incision) seems to be associated with the lowest rates of capsular contracture.  The cosmesis of this incision is also ideal as it is hidden under your breasts.  Armpit incisions have the potential of being seen every time you lift your arms.


The IMF incision also provides the surgeon with the best approach to perfect your implant pocket, alter the IMF if needed, and obtain hemostasis.  Much of the armpit approach involves blind and blunt dissection.


I hope this helps.  Good luck!



Asif Pirani, MD, FRCS(C)
Plastic & Reconstructive Surgeon

Toronto Plastic Surgeon
5.0 out of 5 stars 20 reviews

Armpit incision not used as much any more as other approaches


Your areolae are not too small.   You should know that they will expand about 1 cm in diameter after a breast augmentation.  You could easily have implants inserted through a periareolar incision or inframammary incision.  The transaxillary incision is less popular these days for several reasons.  It can leave a troublesome scar that is visible when you raise your arm.  Also, if you have repeat surgery (and most young women eventually do), a periareolar or inframammary incision will be needed - we cannot usually reoperate through an armpit incision.  Better to minimize scars and have only one set of scars rather than two.  It is also harder to dissect the pockets and get optimal cleavage and symmetry using the armpit approach.  Today I use the inframammary approach in the vast majority of patients.  The scar is kept within the inframammary crease, slightly on the underside of the breast where it is well-concealed and will not show when you wear something sleeveless and raise your arm.

Web reference:

Kansas City Plastic Surgeon
4.5 out of 5 stars 28 reviews

Best Incision for Silicone Implants?


Really you forgot to mention the incision that will have the least problems in your case: inframammary. From your photo, you have developed inframammary folds. With silicone implants this gives the advantage of having the incision off the breast, gives direct visualization of the pocket, and typically heals well. The disadvantage of the inframammary incision is that sometimes the scar can migrate up or down if not placed correctly or closed correctly. The armpit incision for this size implant may end up being quite long and obvious when you raise your arms.

Hope that helps and good luck!

Dr. Babak Dadvand

Los Angeles Plastic Surgeon
5.0 out of 5 stars 6 reviews

Armpit Incision for Breast Augmentation

Thank you for your question. There is quite a range of opinions regarding this option for breast augmentation. For the last 12 years I've done almost exclusively axillary (armpit) incisions though I offer patients the peri-areolar and infra-mammary approach as well. The ultimate shape of the breast is the same for all approaches. 

A distinction must be made between the older way of doing the procedure without an endoscope would be a "blind" procedure requiring a longer incision, and the newer way using an endoscope.The axillary approach when done with an endoscope, (the same instrument that is used to do knee surgery thru a small incision) allows us to make a very small incision. The incision is placed in a natural axillary crease which most patients have. It's been my experience that the resulting scar blends in very well; in most cases almost undetectable. It is not a "blind" procedure. With the endoscope we get much better visibility than with the other two approaches. 
There is a new device called the Keller Funnel which allows us to use a smaller incision to insert a gel implant. The endoscopic axillary approach takes about 30 minutes. Having used all three approaches for almost thirty years, I've found patients having the endoscopic axillary approach heal quicker, experience less soreness, and have better hidden scars.

Having said this it would be important to find a plastic surgeon who is board certified and has considerable expertise with the endoscopic axillary approach. Not all surgeons do. Also many surgeons don't offer the endoscopic axillary approach because of the cost of the instruments and equipment. Ask to see before and after photos of the breast and the scars, and perhaps speak with patients who have had this procedure. 
San Francisco Plastic Surgeon
5.0 out of 5 stars 5 reviews

Breast Implant Incisions


Breast implants are placed into the pocket behind the breast through a variety of incisions.  Some approaches, like those in the bellybutton or axilla (under the arm) are felt to be somewhat more problematic and less precise by many plastic surgeons.  These approaches have more concerns with respect to poor positioning of the implant- these incisions are very remote from the area where the breast implant pocket needs to be meticulously created, and less visualization through these remote incisions can create a less than optimal outcome.  In fact, they are the incisions associated with the most positional revision surgeries that are referred to me  following operations by other plastic surgeons.  While the periareolar incision heals very nicely in the line of change between the pigment of the nipple and the rest of the breast, the inframammary incision lies below the fold of the breast and is hidden in the upright position.  The infra-mammary incision has also been shown to be associated with a lower risk of capsular contracture.  You may have reasons for choosing one type of incision over the other your surgeon should discuss either option with you to provide you with a great scar following your plastic surgery.

Santa Barbara Plastic Surgeon
5.0 out of 5 stars 22 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.