Armpit Incision for Breast Augmentation Because Nipples Are Small?

What is recommended going through the armpit or the nipple for a 350cc silicone implant? I have very small nipples that are very round and on the darker side. please let me know the pros and cons.

The Dr. recommended the armpit because my nipples are small. I am concerned about the scar size on my armpit and I am worried that it will be visible. I don't want to have to worry about these scars showing in the summer time. please let me know your opinions. Photo attached.

Doctor Answers 137

Armpit incision very dependent on surgeon experience

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You will have scars for the rest of your life whatever your choice of incision. You need to decide where you want your scars based on your favorite activities and clothing. You do not want armpit scars if your hobby is ballroom dancing. You may not wish prominent breast scars if you like going topless.

I do a great number of transaxillary (armpit) breast augmentations and do not agree that the final shape is any different than an augmentation through a breast incision.

Placement of a 350cc silicone gel implant through an armpit is very straightforward and will not produce a longer scar than the one needed to go through an inframammary approach.

Incision site for breast implants on women with small areola

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Three incisional approaches are commonly used for breast implant insertion: trans-axillary (underarm area), peri-areolar (from about the 4 to 8 o'clock position of the areolas), and inframammary fold (in or just above the crease below the breasts). No two patients are alike, so it is important to individualize the surgical plan for each patient's individual needs.
An advantage of the peri-areolar incision is that the color and skin texture difference between areolar skin and the adjacent breast skin conceals the resulting scar very nicely. In many patients the scar is almost undetectable after only a few weeks. This incision is commonly used in patients who have had one or more pregnancies and have a medium to large areolar diameter.
The axillary or underarm area incision is ideal for patients with very youthful-appearing breasts, especially younger women with no history of pregnancy. These patients often have a small areolar diameter, which makes the peri-areolar incision less than ideal, and smaller, perkier breasts - where the inframammary fold (and thus a scar in that location) can be easily seen.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Breast Implant Incision Under Breast Best for Silicone Gel Implants

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Thank you for your question.

As you can see from the posted answers opinions vary greatly.

The most important issue is choosing an experienced, Board Certified Plastic Surgeon who does a lot of Breast Augmentation and follow his/her advice.

Generally, Silicone Implants require a larger incision which is easlily accomplished through an Infra-mammary Incison underneath the breast in the Infra-mammary Fold.

In my experience, the need for pocket revision or a secondary procedure is more common following an "arm pit" incision, because this is a "blind procedure"-the surgeon cannot see the pocket he is planning to place the Implant into.

The incision underneath the breast provides excellent visibility for the surgeon and will not be noticeable after surgery.

Incision options with small areola

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Hi Kinzie,


There are several things to consider when deciding on which incision you use to perform your surgery.  Cosmesis and the resulting scar are certainly an important consideration.  Another consideration is the risk for capsular contracture.  When a foreign body is placed in the body, the body reacts by forming a capsule of tissue around the foreign body.  In the case of breast implants, this capsule can be soft or it can become hard and even painful.  They can even distort the implant and result in poor cosmesis.  This is termed a capsular contracture, and the rates of these can be quite high, depending on implant choices and incision type.


Recent evidence seems to indicate that there are higher rates of capsular contracture with peri-areolar (nipple) and trans-axillary (armpit) incisions.  Using an incision in the fold under your breasts (IMF incision or inframammary fold incision) seems to be associated with the lowest rates of capsular contracture.  The cosmesis of this incision is also ideal as it is hidden under your breasts.  Armpit incisions have the potential of being seen every time you lift your arms.


The IMF incision also provides the surgeon with the best approach to perfect your implant pocket, alter the IMF if needed, and obtain hemostasis.  Much of the armpit approach involves blind and blunt dissection.


I hope this helps.  Good luck!



Asif Pirani, MD, FRCS(C)
Plastic & Reconstructive Surgeon

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 35 reviews

Best incision for Breast Augmentation

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Hi there-

I personally would not recommend the armpit incision to you- especially because of your concerns...

With an incision under your breast, you can expect it to remain hidden from view unless you are hiding nothing from view....

Armpit scars are NOT invisible, and the fact that you will have one on each side of your body just makes them even more conspicuous and attention grabbing. Furthermore, I do not believe that most experienced and skilled surgeons would agree that the shape of the breast is as reliably lovely as with the incision under the breast.

Having a cute scar under your arm won't make you happy if your breasts are funny looking.

Incision location for breast augmentation

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With 350 cc implants, I would opt for an infra-mammary incision (within the crease of your breast). Every surgeon has his or her own preference, but placing such large silicone implants through the armpit and nipple can be quite challenging, and in some cases there is a risk of damaging the implant. If your surgeon has a lot of experience with the armpit incision, he or she should be able to show photos of other women's scars. This will allow you to choose the best approach for your surgery. Good luck, /nsn.

Armpit Incision for Breast Augmentation

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Thank you for your question. There is quite a range of opinions regarding this option for breast augmentation. For the last 12 years I've done almost exclusively axillary (armpit) incisions though I offer patients the peri-areolar and infra-mammary approach as well. The ultimate shape of the breast is the same for all approaches. 

A distinction must be made between the older way of doing the procedure without an endoscope would be a "blind" procedure requiring a longer incision, and the newer way using an endoscope.The axillary approach when done with an endoscope, (the same instrument that is used to do knee surgery thru a small incision) allows us to make a very small incision. The incision is placed in a natural axillary crease which most patients have. It's been my experience that the resulting scar blends in very well; in most cases almost undetectable. It is not a "blind" procedure. With the endoscope we get much better visibility than with the other two approaches. 
There is a new device called the Keller Funnel which allows us to use a smaller incision to insert a gel implant. The endoscopic axillary approach takes about 30 minutes. Having used all three approaches for almost thirty years, I've found patients having the endoscopic axillary approach heal quicker, experience less soreness, and have better hidden scars.

Having said this it would be important to find a plastic surgeon who is board certified and has considerable expertise with the endoscopic axillary approach. Not all surgeons do. Also many surgeons don't offer the endoscopic axillary approach because of the cost of the instruments and equipment. Ask to see before and after photos of the breast and the scars, and perhaps speak with patients who have had this procedure. 

William McClure, MD
San Francisco Plastic Surgeon

Armpit incision not used as much any more as other approaches

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Your areolae are not too small.   You should know that they will expand about 1 cm in diameter after a breast augmentation.  You could easily have implants inserted through a periareolar incision or inframammary incision.  The transaxillary incision is less popular these days for several reasons.  It can leave a troublesome scar that is visible when you raise your arm.  Also, if you have repeat surgery (and most young women eventually do), a periareolar or inframammary incision will be needed - we cannot usually reoperate through an armpit incision.  Better to minimize scars and have only one set of scars rather than two.  It is also harder to dissect the pockets and get optimal cleavage and symmetry using the armpit approach.  Today I use the inframammary approach in the vast majority of patients.  The scar is kept within the inframammary crease, slightly on the underside of the breast where it is well-concealed and will not show when you wear something sleeveless and raise your arm.

Eric Swanson, MD
Kansas City Plastic Surgeon
4.7 out of 5 stars 62 reviews

Incisions for silicone breast enhancement

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Silicone implants require, per the manufacturers, an incision of approximately 5 cm in length.  Small areolas don't allow for an incision of this length.  Armpit incisions are okay but unfortunately symmetric incisions are a classic sign of surgery.  So you'll never be able to wear sleeveless tops.

The inframammary incision is the only incision that hides better than the others and causes the lease amount of damage to the breast.  I make the incision 1cm below the fold.  Thus when the implant is placed the skin that is recruited pulles the scar into the inframammary fold.  It can be pulled during closure so that the actual scar will only be about 3cm in length.  No one will see this incision.  Even topless it is hard to see it.  In addition this incision causes the least amount of trauma to the breast tissue.

The logic of this incision far exceeds any of the other incisions.

"Best" incision for breast augmentation

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This is an excellent question. One of the basic variables in augmentation surgery is where the scar is going to be. The important thing to understand is that their will always be a scar. The surgeons job is to ensure you achieve the best quality scar in the least visible location. Also, the surgeon should not compromise technical "perfection" by choosing a scar location that provides less control over what is being done internally to create the implant pocket and insert the implant.

Of course, like most things in surgery you will find differing opinions over what is the "best" approach. 

With implant placement, 3 incisions/scars are commonly used: armpit; lower areolar border; lower breast fold.

Each approach has advantages and disadvantages. 
- Via the areolar is simply not possible when the areolar diameter is too small and therefore you are unable to pass an implant through a small access hole. Also, should the person scar badly it's not a great spot to have a bad scar - although this could be argued for all techniques.
- Via the armpit approach can scar nicely, with no scar associated with the entire breast mound. However, these can scar badly and therefore can never be hidden! A bikini/bra will cover any scar on the breast mound (areolar or lower breast fold). Also, the armpit approach means that the surgeon has the least control and is furthest removed from the areas that he/she needs most control in creating the pocket - the cleavage region. In addition to this, should the patient require any further surgery then it is general not possible to re-use these scars, so the surgeon needs to create another scar (such as in the lower breast fold).
- The lower breast fold incision is by far the most popular approach employed by plastic surgeons, and it is how I do the vast majority of my cases. The scar sits neatly within the lower breast fold crease. This approach provides the surgeon with the best control and management of the entire implant pocket and insertion/positioning of the implant. This scar can also be easily re-used should further surgery be required for whatever reason. 

Furthermore, many would consider that the areolar and armpit approach can result in potential "contamination" of the implant as these areas have a higher bacterial load than the lower breast fold region. Whilst this would logically be correct I'm not entirely convinced it is clinically true and/or relevant. However, its another acceptable argument for not routinely using these approaches.

Eddy Dona, MBBS, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 96 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.