Breast Augmentation Incision Sites?

I am concerned about how to decide which is the best incision site for my breast augmentation. Is one incision type more inherently risky than the others? One of my biggest concerns is loss of sensation or conversely hyper-sensitivity in the nipples. Any help is greatly appreciated.

Doctor Answers (15)

Best Breast Implant Incision Site

+4

Thank you for your question. Be sure to see a Board Certified Plastic Surgeon for advice.

Choice of incision site is a very personal decision made by you. Generally these are important things to consider:

  1. Best visibility for your surgeon for accurate placement and careful surgical technique is the Inframammary Crease-underneath the breast. These scars are well hidden.
  2. Transareolar-through the Areola is a well camouflaged scar. However it can disrupt milk ducts thus I do not use this in women who plant future pregnancy. It is best for the sagging or ptotic breast.
  3. Transaxillary-Through the "arm pit" does hide the scar very well. However it is a "blind procedure" meaning the surgeon cannot see the site of dissection to create the pocket. In my experience revisions are more commonly required to correct asymetry following this approach.
  4. Trans umbilical-Through the Belly Button. Requires a Saline Implant and manufacturer warranty is voided-enough said.


Boston Plastic Surgeon
5.0 out of 5 stars 26 reviews

Breast augmentation incision sites?

+1
Hello! Thank you for the question!  The typical incision used for breast augmentation are: inframammary (in the fold beneath your breast), periareolar (at the border of the areola), axillary (within the armpit crease), and TUBA (through the umbilicus). Incision placement will do a lot with your preference, surgeon comfort level with that approach, and the type of implant - silicone implants will be difficult to place within certain access incisions. Breast augmentation scars are well concealed and are very discrete. They should not be visible within clothing, and likely hidden without clothing. If your concern is the visibility without garments, you should consider remote access incisions such as in the armpit. However, these other incisions heal very well on the breast and often times inconspicuous. 

It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. 

If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.

Consult with a plastic surgeon your goals, concerns, and expectations. Certainly incisions should be considered, but should not limit your overall result by hindering visualization and access to your surgeon, and what produces the best results in his/her hands.

Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 11 reviews

Breast Implant Insertion Locations

+1
Generally there are four breast incisions that are used to place implants.  Like any thing in life, there are pros and cons to each site.  Discuss with your Board Certified Plastic Surgeon which incision is best for you.  Nipple sensation changes have been associated with all incisions.  The size of the implant has more to do with nipple sensation changes than does the incision site.  

  1. Inframammary fold incision (IMF) - Probably the most common site for breast augmentation is the U.S.  This incision is placed directly in the fold under the breast.  It allows good visualization for the surgeon and is well hidden.  The rate of capsular contracture is lower versus the periareolar incision.
  2. Periareolar incision - This incision is placed under the areola where the areola meets the skin.  It can heal very well and be almost imperceptible at times.  However, if it does not heal well, the scar is directly on the front of your breast.  The rate of capsular contracture has been shown to be higher with this incision in studies.
  3. Axillary incision - This incision is placed high in the axilla.  The good thing about this incision is that there are no incisions on your breast.  The bad thing is that when you have on a sleeveless dress, shirt or swim suit, you may be able to see the incision.  Both saline and silicone implants can be placed through this incision.  Large silicone implants become more difficult to place from the axillary incision.  The use of an endoscope can make this procedure more precise.
  4. Umbilical incision (TUBA) - The umbilical incision is used to place a saline implant from your umbilicus.  The good thing is that there are no scars on your breast.  Only saline implants can be placed through this incision.  
Thank you for your question.  

Ralph Trey Aquadro, MD
Auburn Plastic Surgeon
5.0 out of 5 stars 5 reviews

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Incision

+1

The best incision for you is the one that best fits your needs and will give you the best outcome. Your surgeon should be able to advise you well.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 9 reviews

Site of incision for breast augmentation

+1

Dear Terri,

Thank you for your inquiry.

Usually, 4 main sites of incision are considered with breast augmentation surgeries:

1. IMF (inframammary fold) incision.

2. Circumareolar incision.

3. Axillary incision for trans-axillary implant insertion.

4. TUBA (trans-umbilical breast augmentation).

Depending on the type of implants chosen (silicone vs saline) as well as the size of the implants (especially with silicone) that the size and the location of the incision are determined. For example, if a patient is to consider a 600cc gel implant via a trans-axillary insertion vs a 200cc one then the patient is to anticipate a larger incision at the axillary region with the 600c implant than the 200cc!

Infection wise and development of capsular contraction seem to be the lowest with the IMF point of entry and the incision is fairly hidden at that area without any limitations applied to the size of implants the patient desires to have.

That being said, please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of additional corrective surgeries dramatically.
I hope this helps and please feel free to check the website below.

The best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 108 reviews

Breast augmentation incisions

+1

I do not think incision site affects nipple sensation.

Incision site is strictly patient choice. The armpit incision hides with arms down, but is visible if you raise your arms in anything sleeveless. Augmentation through the armpit incision may have a higher incidence of implants staying higher.

Gregory Sexton, MD
Columbia Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast surgery incision

+1

The incision really does not impact the sensitivity according to reports. It is a matter of basic anatomy, size of implants, type of implants, and personal/patient preference.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Breast Augmentation Incision Sites? Nipple sensation

+1

Dear Friend,

 

GIven your concern regarding nipple sensation I think you would be better off with a inframammary incision.  These are relatively small 4cm incisions placed along the IMF.  Once the implant is inserted the incision will sit right at the base of the breast (high enough ) so you can wear your two piece with no visible incision. Really a great approach to breast augmentation.  

Mary Ella Carter, MD
Washington Plastic Surgeon

Nipple sensation is a very important issue

+1

All incisions have some risk of reducing sensation in the nipples.  The risk does seem higher with incisions under the areola as a lot of the nerves that provide sensation are in this area. 

In my practice, my preference is for the transaxillary endoscopic approach, which uses an armpit scar.  Sometimes we encounter some of the nerves that give sensation to the breast but these can be easily preserved.  Almost all patients preserve sensation to their nipples when we use this type of incision.

Shim Ching, MD
Honolulu Plastic Surgeon
4.5 out of 5 stars 10 reviews

Breast Augmentation Incisions Choices, Risks, and Nipple Sensation Changes

+1

Hi Terri,

There are multiple decisions to make regarding breast augmentation and incision location is just one of them. The incision options that are utilized in breast augmentation each have their unique advantages and disadvantages. These options are: periareolar (around the nipple/areola), transareolar (through the areola), inframammary (under the breast), transaxillary (arm-pit), and transumbilical (through the belly button). Each patient must be evaluated individually to decide which one to choose based on her anatomy and aesthetic concerns.  There is not one incision that is clearly more risky than others.  It is sometimes more difficult to create a precise, natural appearing pocket for a breast implant when performing the surgery through a remote incision (arm pit or belly button) without the use of an endoscope (camera). There is also great debate as to whether or not going through the milk ducts of the breast (periareolar) increases the risk of capsular contracture (hard shell around the breast).

 

Regarding breast sensation changes: many surgeons have had concern with the periareolar incision theoretically because of the proximity of the incision to the nipple. However, a recent study has shown that the only difference between the inframammary and periareolar incisions is a decreased sensation with the former at the inferior pole of the breast. When changes occur, sensation usually returns after six months.  Patients who were most effected by sensory changes were over age 35. A large implant size may also have mal-effects on breast sensation. 

 

I hope that this helps!

Jeremy White, MD
 

Jeremy B. White, MD
Aventura Facial Plastic Surgeon
5.0 out of 5 stars 7 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.