Transaxillary vs. Periareolar Breast Augmentation

Me and my husband are arguing about haveing the transaxillary incision. I'd rather do the Periareolar one. Which is best?

Doctor Answers 33

My wife and I disagree on the incision!!??

you are not having the surgery.  it is not on your body and you are crazy to do anything other than support her decision. if there is a sound medical reason to do one incision over the other then it is between your wife and her surgeon. so sit in the corner and nod. 

Boca Raton Plastic Surgeon
5.0 out of 5 stars 1 review

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Compromise - use the Inframammary Incision!

This is compromise at it's best: neither of you get your first choice, but your wife ends up with a great - arguably the greatest incision.

Most patients and plastic surgeons sophomorically focus on the location of the scar as the most important issue in deciding on the incision. In fact, the scar is the least important distinction between the incisions.

Why? Because any of three locations almost always gives a good scar. When it doesn't, it is usually related to patient biology, such that someone who gets a bad scar in one location would get it in another. If any incision always gave a perfect scar, we'd all use it. And if any always gave a bad scar, no one would use it.

The transaxillary incision fundamentally doesn't makes sense to me personally: it is the only incision that is visible when fully dressed; when a revision needs to be done, it almost invariably requires another incision; you can lose sensation in the armpit making shaving difficult; unless done endoscopically, it is less accurate and typically more painful and bruised than other approaches; if done endoscopically, it takes much longer in surgery.

The periareolar yields a scar that is visible when the breast is viewed head on; the size of the areola can limit the size of the implant; the size of the areola and the amount of breast tissue limits the visualization and thereby accuracy and bloodlessness of the pocket dissection; and most important of all, dragging an implant through the breast contaminates the implant with the bacteria in the breast, the very bacteria implicated in capsular contracture (hardening.) The best study of its kind shows a statistically significant higher rate of capsular contracture with the periareolar incision than the inframammary incision.

The inframammary incision is hidden in the crease under the breast; it has the least swelling of hte breast since the breast gland itself isn't cut; it is an incision that can be used for any type of revision necessary in the future; it allows for complete and total visualization of the surgery; it allows all implant types to be placed with a minimum of trauma. And once augmented, the scar is up and under the breast, right at the crease where the breast meets the chest wall, an area that frequently has a bra mark that is even more visible than the scar itself.

My suggestion: go inframammary. From your relationship's point of view neither of you lose the argument. And from a medical point of view your wife gets what is to me the most reasonable incision choice.

Steven Teitelbaum, MD
Los Angeles Plastic Surgeon
4.5 out of 5 stars 34 reviews

Transaxillary vs periareolar vs crease breast augmentation incisions

The transaxillary incision is much less commonly used than it was several years ago. I have treated several patients from my area with misplaced implants through the armpit and even two whose doctors burned through the skin in the lower inner corner of the breast getting lost in where they were in the pocket dissection. Some revisions cannot be done through the armpit so another incision is needed. Finally, the numbness in the upper inner arm that can occur has made this less popular.

The areolar incision is nice but is sometimes limited in that some areolae are not big enough to place a desired silicone gel implant in through without damaging the integrity of the implant. A periareolar (around the entire areola) incision allows for larger implant insertion plus a modest breast lift.

Finally, the crease is a workhorse incision in this as any size implant can be inserted and all revisions can be done through the crease.

Best incision for breast augmentation

There are many great answers and I agree with most of them. Each plastic surgeon has their own philosophy. My best advice is to let your wife and her plastic surgeon decide. This is a big decision and she must consider not only the positives, but also the negatives.

The only advantage to the transaxillary incision is that you don't have a scar on the breast. There are, however, many negative to this approach: (1) a scar in the axilla can be seen when raising the arms, (2) if the scar becomes hypertrophic it may interfere with shaving, (3) the implants have a tendency to ride high because of the dissection during implant placement, (4) it is hard to place large silicone implants through this approach, (5) surgery time (and hence, your cost) tends to be longer, and (6) subsequent surgeries tend to require a second incision. In other words, when it's time to have her implants replaced, it is unlikely that your plastic surgeon with use this approach again - especially if she needs a breast lift or capsulectomy. The result is that now she will have two incisions.

The periareolar incision is a good approach, especially if she need a small lift at the same time. When it heals well it looks great. But there are a few things to consider. This approach puts the incision right on the breast. Therefore, if the incision doesn't heal well (scar hyperthrophy, widening, darkening) she will see this everytime she looks in the mirror. There is also an increased risk of infection. Nevertheless, if your wife has dark, moderately sized areolas, this could be a good approach.

Usually, I recommend the inframammary (under the breast) approach because it is quick, straightforward and the scar is well hidden when looking at the breast straight on. It is also easy to perform a revision through this approach. When I combine this approach with a dual plane breast augmentation (for ladies with some sagging after children) this gives a very nice predictable result.

Hope this helps

What Incision is Best?

This is a good question as the majority of patient that wish to have a breast augmentation desire a result that is going to feel and look natural without having obvious scars.

There are several ways to place the incision so that it is well hidden in natural skin folds or breast transitions.
  • 1.Periareolar
    • a.Hidden at the natural transition from the areola and the breast skin. The incision can be hidden in this natural color transition
  • 2.Inframmary Fold
    • a.The incision is hidden in the fold below the breast.
  • 3.Axilla
    • a.The incision for the implant can be hidden in one of the natural axilla folds. I do these with the aid of scope which allows precise placement of the implant.
    • Also the use of the Keller funnel has allowed the placement of larger silicone implants  through the axilla. 

No one incision is best for every patient and the majority of patients can have the implant placed through any of the three incisions listed above. When do correctly all three of the incisions are well hidden.

It is important to see your board certified plastic surgeon to help guide you to an implant that will give you an aesthetically pleasing breast.

Your choice, not his

It really should be your choice, as you are having the surgery. It's your body. Talk to your surgeon and determine which is the best for YOU not for him. You're the one who has to live with it!

Transaxillary vs Periareolar Incision for Breast Augmentation

All breast augmentation incisions have their pros and cons. If you do not have a small areola then a periareolar approach is reasonable and the scar is more camouflaged. However you should be aware that there is a higher risk of capsular contracture and not being able to breast feed with this approach. A transaxillary approach also has a higher risk of capsular contracture and has no breast scars. An inframammary approach would probably be the safest with least risk of complications with the scar tucked beneath the breast to hide it.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 59 reviews

Transaxillary vs periareolar breast augmentation

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.  The transaxillary incision is much less used today due to its blind approach and inability to shape the breast pocket as precisely as with the inframammary or even periareolar incision.  Especially if you are in need of a breast lift, the periareolar incision may be the better option in this case. 

Hope that this helps!  Best of luck on your decision and for a great result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 13 reviews

There is no reason to argue about the best incision...

Breast augmentation can be performed utilizing either the inframammary, periareolar or transaxillary approach with either silicone or saline implants.  There are pros and cons to any of the incision choices depending on each patient's unique situations.  It is best to visit a plastic surgeon who is comfortable with all three approaches to help guide you in your choices for a great breast augmentation result.

Sanjay Grover, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 124 reviews

Choosing the "best" incision for your breast augmentation

Choosing the best incision for breast augmentation

There are basically four choices of incision for placing breast implants  - Inframammary, per-areaolar,  transaxillary and trans-umbilical.  Choosing the incision for placement of the implants which is best in any given situation can be affected by many factors – these can be broken down into patient specific factors and surgeon specific factors.

Patient specific factors include ethnicity and tendency for poor scarring (some ethnic groups have a propensity for hypertophic or even keloid scarring), pre-existing anatomy (e.g.  Is a given patient’s areolae large enough for placement of a pre-filled silicone implant?)

Surgeon specific factors tend to include the biases and experience of the surgeon, which should not be discounted or taken lightly. 

My personal experience after over 3000 breast augmentation is that inframammary and peri-areolar incision give the most control over the breast implant pocket and that transaxillary and trans-umbilical incision have a higher revision rate.

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.