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Help with Breast Augmentation Incision Decision

asked 1 year ago by 7080anon in Washington
Latest answer by Jaime Perez MD
Question viewed 1,086 times
Tags: asymmetry, choices, incision

Happy Holidays! I am considering BA to fix my breast asymmetry (as much as possible) and enhance volume. I have consulted a few surgeons but I am still confused as to which incision will work better for me. A couple suggested periareolar (since I don't really have a fold) the other two suggested inframammary. I am of hispanic descent (if that makes any difference in regards of scar healing and such). What is your opinion? Would the transaxillary incision work for me at all? Thank you :)

33 answers to Help with Breast Augmentation Incision Decision

+2

Best Breast Augmentation Incision

Thanks for the question.  You have several options for the breast augmentation incision as I am sure you were made aware of during your consultations. I prefer the peri-areolar incision, as it provides several advantages over the other incisions.  Additionally, the scar blends in the excellently with the surrounding breast tissue. Irrespective of which surgical approach your surgeon uses, you will in all likelihood have a favorable result if the procedure is performed by a... more
Glenn Vallecillos, MD

Beverly Hills Plastic Surgeon

www.BeverlyHillsCosmeticSurgeon.com

+2

Which Incision is Best for Breast Augmentation?

Your breast asymmetry is mild based on this photo with the right breast being slightly larger than the left.  The incisions all have different advantages and disadvantages. Without going into an explanation of all of the advantages and disadvantages I will tell you my preference. I would use a periareolar incision in your case because 1) your areola are a good diameter to accommodate a saline or silicone implant, 2) it gives me direct visualization of the entire implant pocket,... more
Babak Dadvand, MD

Los Angeles Plastic Surgeon
+2

Incision choice in breast augmentation

Incision choice is always a concern in breast augmentation.  If you scar well, it does not really matter.  If you have a history of poor scarring, you have to think about where you would want your scar hidden.   Most sleeveless garments will show a armpit incision.   Some swimsuits will show an inframammary incision.   Some patients do not want thickened scar around their areola. Generally, patients that scar poorly will choose the... more
Paul S. Gill, MD

Houston Plastic Surgeon

www.drpaulgill.com

+2

There Are Numeroius Factors That Can Affect The Incision Location In Breast Augmentation

Breast implants can be put in through multiple incisional approaches as you know. The incision is not the important part of the breast augmentation operation, the breast implant is. The incision is just a way to get there and most breast implants can be put in through any of the available incisions for the most part. (exception of silicone implants through a small armpit incision) However, in patients with more skin pigmentation, the resultant scar from the incision may make a difference... more
Barry L. Eppley, MD, DMD

Indianapolis Plastic Surgeon
+2

Breast augmentation for asymmetry

Most women have some asymmetry, and most plastic surgeons should be able to correct such asymmetries through multiple approaches.  I think that you should feel comfortable if your surgeon has explained the options to you, as well as what expectation you should have with each option.  I would feel comfortable with any approach/scar location. 
Jonathan Heistein, MD

Fort Worth Plastic Surgeon
+2

Incision location

The incision choice is multifactorial.  If you are having gel implants your areola may not be large enough to place them in that way .  The incision for transax would also be longer as well and possibly more noticeable.  Salien can go through any of the incisions.  Some approaches give better exposure than others.
Steven Wallach, MD

Manhattan Plastic Surgeon
+2

Which incision is best for breast augmentation?

Great question! One of the most common questions that we get asked by our clients is which incision is the best for them.  In your case, your breasts are relatively symmetric and so you could really use any of the three incisions available to you.  That being said, keep in mind that there is no perfect incision and this is not only a personal decision for you but also a decision that should be made with an experienced Board Certified Plastic Surgeon so that he/she... more
Gregory A. Buford, MD

Denver Plastic Surgeon

www.beautybybuford.com

+2

Breast augmentation

The best approaches are inframmary and peri-areolar.  With silicone gel implants, infra-mammary would be the best, but per-areolar can be done as well.  If saline, then per-areolar approach for you (based on your photo), only because it would hide the scar better!  This is my opinion only!
Shahin Javaheri, MD

San Francisco Plastic Surgeon
+2

Choice of incision for breast augmentation

From the photo view I would say that the asymmetry is within normal variance and is best ignored. Implants only deal with volume asymmetry.  The issue of incision choice is one that should be best made by the surgeon based on prior experience of the surgeon as well as others. Unlike choice of the implant type and implant profile which should be up to the patient, technical issues and experience count for far more on incision choice.  I would argue that the consensus of... more
Scott L. Replogle, MD

Denver Plastic Surgeon
+2

Breast augmentation with implants: incision and scar considerations

AT this point in time the inframammary is the most popular fo several reasons. It is the most direct approach to under the muscle placement without transecting the ducts allowing the placment of a sufficiently lengthy incision for use of silicone gel filled implants. That having been said, in my practice, I am equally divided between the periareolar and the fold incisions. I sometimes favor the peri-areolar incision because it allows minor manipulations or lifts of the... more
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+2

Breast augmentation incision decisions

From the photo you have the choice of either the infra mammary incision or the transaxillary (TA) incision. Each has it's advantages and disadvantages. Through the inframammary incision the asymmetry can be corrected and a silicone implant can comfortably be placed. As for the TA you are limited to a smaller silicone implant or a saline implant. The scar can be well hidden in the creases of the axilla. The best of luck on whichever one you choose.
Dana Khuthaila, MD

New York Plastic Surgeon

www.drkhuthaila.com

+2

Breast Implant Scar Placement

Happy Holidays to you also.   In reviewing your photos your left and right breast are slightly different.   Most women have a some differences in their breasts.   My preference for the incision of the breast implant has always been the inframammary fold.   This incision gives the best results for creating the breast pocket and the placement of the breast implant.  I find this incision is the most reliable and leads to much less revision due to breast placement.... more
John Ward, MD

Phoenix Plastic Surgeon

www.johnwardmd.com

+2

Which incision approach is best for asymmetry of the breasts

I find that whenever there is asymmetry, nothing beats an inframammary incision for unparalleled exposure of the breast pocket as well as precision in correcting asymmetry. It allows precise assessment of the lower edge of the implants to ensure that they are even. Also, as the creases will almost certainly need to be lowered in your case, the incisions can be placed within the new planned creases to minimize visibility after surgery.
Mark D. Epstein, MD

Stony Brook Plastic Surgeon
+2

Incisions in breast augmentation

Well placed incisions end up usually giving excellent scars. I would suggest either an inframammary incision or a periareolar incision, depending on  the size of your implant and choice of saline vs. silicone.  By the way, nothing will "fix" breast asymmetry. You have some modest asymmetry that may be better if implants of different sizes are used, but you will never be equal no matter what different implants are used. Everyone has differences in their breasts (including... more
Francisco Canales, MD

Santa Rosa Plastic Surgeon
+2

Breast Augmentation Incision Decision

Interesting question. Thanks for posting the photo. All these 3 incisions are popular. each only has been the #1 over the years, each rotating in popularity. Today the infra mammary is the "new" hot one. For you scarring not an issue.I recommend either the infra or peri before the trans, but I do all 3. Go luck and happy holidays from MIAMI Dr. Darryl J. Blinski 
Darryl J. Blinski, MD

Miami Plastic Surgeon
+2

Breast augmentation through inframammary incision safest.

Hi. You have small areolas and your folds need to be lowered somewhat.  The scars are almost never an issue in breast augmentation.  If you are unhappy after wards, it will be because of bad shape or symmetry. I think you have the best chance of having a good result with infra mammary incisions. see video
George J. Beraka, MD

Manhattan Plastic Surgeon
+2

Transaxillary breast augmentation will keep the scar off the breast

There are trade-offs with all breast augmentation incisions, and no one approach is right for all. Given your skin type and the fact that you have no fold in which to conceal a scar, I would favor a transaxillary  or under the arm approach to keep the scar off the breast and out of sight. Best of luck, peterejohnsonmd
Peter E. Johnson, MD

Chicago Plastic Surgeon

www.peterejohnsonmd.com

+2

There are pros and cons to each breast augmentation incision option

As others have said, since you don't have a distinct fold, an inframammary scar may be quite visible, especially with your skin type.  Where I differ with some of the other posts, is that I also believe a periareolar scar will potentially be very visible.  I always hear or read from surgeons how the periareolar approach is so discreet.  I disagree.  It can heal discreetly, but not always.  There is an unpredictably to it, as well as the fact that some areola/skin... more
Douglas J. Mackenzie, MD

Santa Barbara Plastic Surgeon

www.pacificplasticsurgery.com

+2

Choice of Breast Augmentation Incisions - Which is Best?

IF there was an absolute, "no doubt about it", "don't you even dare think about another" Breast Augmentatin access incision the vast majority of Plastic surgeons would be using that incision. Unfortunately, breast augmentation incisions have both positive and negative attributes so it comes down to your surgeon and you to decide which set of plusses you are willing to accept over which potential drawbacks. I have used all conventional breast augmentation incisions over the years and found... more
Peter A. Aldea, MD

Memphis Plastic Surgeon
+2

Breast augmentation incisions

There is no right answer but if you don't have crisp inframammary folds and if you do have a sharp edged areola in a darker skinned person, the infra-areolar incision would usually be my choice though I am more of a fan of the crease for most people.
Richard P. Rand, MD, FACS

Seattle Plastic Surgeon
+2

Breast augmentation incision decisions

You are in a quandry that many patients find themselves in. Your answer depends on how you live: if you like to be in skimpy swimsuits then a nipple or axillary incision may be for you. If you seldom wear a swimsuit like a bikini then it won't matter. I find that the inframammary incision is easier to work with and I have the fewest problems with it. However, I have successfully used the other incisions too. You need to weigh the advantages and disadvantages of each and discuss it with... more
Victor Au, MD

Chapel Hill Plastic Surgeon
+2

Simplifying the decision about breast augmentation incision

The reason you have heard different opinions is because there is no single best answer. With your skin type, an important consideration is pigmentation of the scar. If it is placed at the edge of the areaola, then it would be well-disguised, but potentially more obvious at the inframammary or axillary location. The periareolar incision does not affect nipple sensation as some believe so ignore that. Implant type and size may influence the decision too, since a slightly longer incision is... more
Richard Baxter, MD

Seattle Plastic Surgeon
+2

Breast augmentation scar choices

If you are interested in a reasonably sized silicone implant, the peri-areolar scar would work well for you. This approach preserves the important infra-mammary fold tissues which are sometimes disrupted from an infra-mammary approach. 
Scott Sattler, MD

Bellevue Plastic Surgeon
+2

I like circumareolar.

This is a scar that is always covered by a bathing suit. The inframammary is easier, but when a small bikini top rides up, it can be seen. Axillary - use once to put in but if you have a problem or need another surgery , usually you need another incision. In my practice, I encourage a circumareolar incision and believe it is the best>
William B. Rosenblatt, MD

New York Plastic Surgeon
+2

Breast augmentation

Your photo shows fairly symmetric alignment of the nipples, level folds under the breasts and a right breast larger than the left.The breast tissue is fairly well centered under the nipples. You will obviously need a larger implant on the left to even you out. This could just as easily be done with an armpit or areola incision. If you go through the armpit you will need a saline under the muscle so that the left can be inflated more than the right. If you go through the areola you could... more
Aaron Stone, MD

Los Angeles Plastic Surgeon
+2

Incision Indecision

I know it sounds funny but it is true.  Many patients don't know which way to go.  There are pros and cons to each.  Using silicone requires a slightly larger incision and that may affect the periareolar approach as a choice.  If you are trying to go large then I would go inframammary.  You do have a fold although it is not well defined.  I would not recommend trans axillary or umbilical with silicone but would consider those if you were using saline... more
Steven Schuster, MD

Boca Raton Plastic Surgeon
+2

Breast augmentation incision

There are advantages and disadvantages to each incisional approach. The main advantage to inframammary is that it is the simplest, most direct route to place the implant. The disadvantage is that it can move relative to your inframammary fold as you age and may be visible in patients without a good fold to begin with. The periareolar incision heals with the least perceptible scar statistically speaking and is ideal for patients like you who have a well-defined periareolar border, is... more
Robin T.W. Yuan, MD

Beverly Hills Plastic Surgeon
+2

Breast augmentation decision

It is confusing, because there is no one best answer.  Typically, the inframmamary incision is used because it is a very straight course to submuscular implant placement.  The less disruption of breast tissue, the less scar tissue that can be present, and affect mammography.  Also, if the scar does not heal well, it is less visible.
David A. Lickstein, MD

Miami Plastic Surgeon
+1

Incision Decision...

By just looking at your picture I would say the axillary, or armpit, incision has the obvious advantage of not placing scars directly on the breast itself. With this incision, an endoscope (i.e. a retracting device with attached camera) is used to aid in visualization during the surgery. This incision placement is best for patients with small breasts who have an indistinct inframammary fold.
Jaime Perez MD

Tampa Plastic Surgeon
+1

Which Incision Is Best for Breast Augmentation?

Obviously, the best incision is one that is optimal for you. There are 3 incision options; 1. transaxillary 2. around the areola 3. and the inframammary fold. My preferred incision is the inframammary fold if you have indeed any breast tissue or a well-defined inframammary fold. If you have any type of asymmetry this gives you the most optimal access incision with the least amount of complications or revisions and the least potential for nipple sensory loss. There is a higher chance for... more
Rod J. Rohrich, MD

Dallas Plastic Surgeon
+1

Incisions for Breast Augmentation - Where to Place the Scar?

All three approaches are good options and can provide excellent results. I perform all three, and each approach has pros and cons which you need to consider. The transaxillary approach creates a scar away from the breast, which may be visible when you raise your arms in a bathing suit or sleeveless shirt. High riding implants can result with this approach, but are usually avoided by an experienced surgeon. The periareolar incision is quite popular and creates a scar which is well hidden... more
Frank Agullo, MD

El Paso Plastic Surgeon

www.elpasoplasticsurgery.com

+1

Incision for breast Augmentation

The incision that is used will depend on the type and size of implant and other factors that are patient driven. The least visible incision is the areolar incision. The problem is that if the areola is small, silicone gel implants may not fit through that incision. Also there is a slight increased risk for loss of nipple sensation with this approach. Silicone gel is not recommended through the axillary incision. The most common is the inframammary incision and if done properly the... more
John P. Stratis, MD

Harrisburg Plastic Surgeon

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