African American w/Hyperpgimentation - Best Incision Site for Breast Augmentation?

As an African American, with (Hyperpigmentation) Wots the Best Incision Site for Breast Enlargement?

Doctor Answers 11

Hyperpigmentation of Scars with Dark-Pigmented Skin

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I recognize some prefer the periareolar approach, yet there is still the risk of hyperpigmentation and scar thickening with EVERY incision.

Consider preop and post-op use of "bleaching creams" (hydroquinone).  I treat my patients with hydroquinone cream twice daily for two weeks preop and resume hydroquinone at 4-6 weeks post-op to try to minimize the risk of hyperpigmentation.

Combining the above with scar therapy cream, post-op may be wise.

Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

African American w/ hyperpigmentation - best incision site for breast augmentation?

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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 28 reviews

Hyperpigmentatuion scars

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The choice for implants can be through the armpit, along the border of the areola, and underneath the breast fold.  All may be problematic. You will have to follow closely with your plastic surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Areolar incision for patients with scarring and pgimentation problems

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With a higher likelihood of hypertrophic scarring or hyperpigmentation, I generally prefer the peri-areolar approach. Discuss the risks and benefits with your surgeon

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Best breast augmentation procedure for patients that scar poorly.

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The answer to this question is quite simple. The transaxillary approach (armpit incision) leaves a well hidden scar leaving no marks on the breast. When performed with an endoscope, by an experienced surgeon, this approach is superior to any other.

Now, with the use of the "Keller Funnel" I am able to insert gel implants through the armpit, giving my patients the best of both worlds. The nipple incision is obvious, and the incision in the fold of the breast might not be visible when you are upright , but  at some point one does recline, and the scar can be outright unsightly. I wrote a short article that can be found in my website, or in the research section of I hope this helps...

Hyperpigmentation of Scars

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Hi there-

As you can see, there are a great many opinions about this, and it should highlight to you that the placement of the incision is most often related to the individual surgeon's comfort with that approach...

Putting my own preferences aside (as much as I can), here's what makes most sense to me... 

Understanding that because of your skin type, you are at high risk of pigmenting your scar no matter where it is placed, where would it be easiest to hide if it does pigment? My opinion- under your breast....

If your scar pigments around your areola or under your arm, it will be obvious, especially as you would have one on each side... Whereas placing them under your breasts would allow them to stay hidden (even when you are not wearing any clothing) until they fade.

More importantly however, is understanding that there are definitely technical details that can minimize your risk of pigmenting your scars- find the best surgeon you can and discuss this with them. With minor modifications in technique, the risk can be lowered.

Breast Augmentation Incisions in People of Color

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Dear Sarah,

First question is what injury or incisions have you had in the past that have produced unfavorable pigmentation. Hyperpigmentation is usually caused by inflammation or hormonal influences.  I would advise you to visit a board certified plastic surgeon to evaluate your previous scars.  If you have unfavorable healing by exam then I would recommend an axillary incision.  A transumbilical incision is possible (done plastic surgeons who have extensive experience via this incision) or a well placed crease incision in a well defined crease.  I probably would recommend saline implants because the incisions are much smaller for these implants.  Good Luck.

Dr. ES

Breast Implants Incisions

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The most common  breast implant incisions are under the breast or around the areola.  Either location is a good choice in the appropriate patient.  The issue of hyperpigmentation is real for patients with this tendency.  However, either incision location is still okay.  Special steps can be taken with creams and injections which can help minimize the chance of pigmentation changes.  Good luck.

Breast Augmentation incision.

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I believe the inframmary incision is usually the easiest to conceal and will give the least number of problems.

If a problem develops it can easily be treated and covered up and usually with the breast tissue coming down after an augmentation it is partially covered. 

Walter D. Gracia, MD
Fort Worth Plastic Surgeon
4.7 out of 5 stars 3 reviews

Periareolar Incision is Good for Augmentation

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I feel that the periareolar incision is good for all cases and especially in patients prone to form hyperpigmented scars.  The reason is that there is already a color contrast here and therefore the incision tends to blend in better.  It can sometimes be difficult to place a silicone implant through a periareolar incision if the areola is quite small, but there is never a problem with a saline implant since it can be placed deflated and filled after it is in position.

John Whitt, MD (retired)
Louisville Plastic Surgeon

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.