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Should I Replace my Saline Implants with Silicone Through Nipples or Under the Breast?

I have saline implants for 7 years, through my nipples, and want to replace them with silicone. But one doctor wants to go under the breast instead of through the nipples. He says it's easier and better that way, and that the silicone won't fit through the nipples Another doctor wants to go through the nipples again. Please advice which way is best. The original way through the nipples or under the breast.

Doctor Answers 21

Areolar or Breast Crease Incision? What to do?

Thank you for this interesting question. To decide which approach may be better, I first carefully examine a patient and ask their preference.   If a patient has a history of breast augmentation through the areola and desires a new set of implants, I usually will re-use the original incision.  However, if the patient desires new implants of a larger size which will be difficult to place through the areola, I will offer placement of the implants through a different incision, such as the breast crease.   

It is important to consider that the risk of capsular contracture is likely greater when larger implants are placed through the areolar incision when the areola is small in size.  This is likely due to the exposure of nipple-associated bacteria to the implant surface.   There is likely less chance of bacterial contamination of a larger implant when placed through a breast crease incision which is of the appropriate length.  Hope this helps!

Los Angeles Plastic Surgeon
5.0 out of 5 stars 18 reviews

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Breast Implants Replacement Through The Nipple

I would suspect you are having your implants replaced because of the feel or rippling. The choice of the incision is purely a personal preference of your surgeon. If the implant is large and your areolar incision is small, the using an incision under the breast might be better. If possible I would try to use your old incision unless you have a history of capsular contracture.

Richard Linderman, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 9 reviews

Implant replacement thru the nipple or beneath the breast

As someone who gets referred a lot of revision breast surgery, I'm going to disagree slightly with my colleagues and suggest that revision thru the periareolar incision with gel devices can be significantly more difficult a procedure, particularly with larger devices.  Unless the patient is getting some kind of associated periareolar mastopexy, the precision of the IMF approach (particularly for retropectoral implants) is going to be superior for this and produce less potential step off by having to go thru and replicate the breast tissue disrupted by a periareolar disection.  I've seen a number of wierd contour problems on some of these redo's  from periareolar implants where the breast tissue closure creates an almost uncorrectable ripple or step off  that's made more me more circumspect in accepting a small second scar on the IMF.

Robert Oliver Jr., MD
Birmingham Plastic Surgeon

Silicone Breast implant augmentation surgery through nipple or crease

These recommendations are typical of differences in opinion and there is no right or wrong answer. Do you like Coke or Pepsi? Why? Some people believe that going through the nipple potentially adds bacterial contamination and biofilm formation. However it is generally a better scar. IT is a trade-off in any case.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 54 reviews


Generally speaking, plastic surgeons always try to make use of pre-existing scars.  However, since a silicone implant is being inserted in this case, if your board - certified plastic surgeon feels that the incision would be too small or is worried about stretching the tissue or decreasing sensation to the nipple, then they may advise to put the scar under the breast.

Samer W. Cabbabe, MD, FACS
Saint Louis Plastic Surgeon
4.0 out of 5 stars 10 reviews

Incision for revision breast augmentation

As you are aware, there are multiple ways to do a breast augmentation and every surgeon has there preferred approach.  For a revision, it is most aesthetically pleasing to go through the original incision so you do not have two scars on your breast.  As long as your original periareolar incision healed well, I would recommend staying with that approach. I hope this helps in your decision.

Kindest regards,

Neil J. Zemmel

Silicone Incision Point

I would use the Keller Funnel device and with that you can fit the Silicone implants thought the areola incision if desired or through the armpit incision.

Robert N. Young, MD, FACS
San Antonio Plastic Surgeon
4.5 out of 5 stars 43 reviews

Best Replacement Incision


There is no one best access incision for every person, and it should be considered individually.  The factors involved to determine which on is best for you are numerous including skin type, breast shape, and your preference among others things.  Additionally, some surgeons, including myself, have reservations about certain places for incisions because of concern for bacterial contamination and capsular contracture. 

In your situation, you already have an incision, and that usually is what most surgeons would use to replace your saline for silicone implants.  Assuming you have had a good result with your saline implants and no capsular contracture, than it would be safe to use the same incision again, assuming it is large enough for silicone gel implants. 

Best of luck to you!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 40 reviews

Incision choice for breast augmentation with silicone.

The decision to use periareolar (around the nipple) incisions for breast augmentation with silicone implants depends on the diameter of the areolas and the size of the implants. Silicone implants require a larger incision in general than saline. This is because the saline implant is placed into the breast, then inflated. I feel that if I can place the implants through the previous scar without making a new incision, that is the better option.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 12 reviews

Replacement of silicone implants through nipples or under the breasts

The decision to replace saline implants with silicone is a common one.  The choice of incision is dependent upon many variable.  The first should be a question of the pre-existing incision.  All attempts should be made not put any additional scars of the body.

Peter D. Geldner, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 16 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.