What's the Best Kind of Breast Augmentation Procedure?

On some breast augmentation boards, many ladies rave about putting the implants fully under the muscle since the muscles fully support the implants and help prevent them from bottoming out and wrinkling.

Also, there's supposed to be less risk of CC's (Capsular Contraction) with this placement plus, even in very thin patients, implants are hardly visible and palpable. I really like the idea, together with the idea of transaxillary incision, but the surgeon I have chosen doesn't share my enthusiasm.

In his opininon, lower implant pole will not look natural and the muscle will never stretch for implants to expand. We have also discussed placing last 1/3 under fascia but that seems to be the problem when using transaxillary incision. What do other experts think?

Doctor Answers 9

The best augmentation is what you feel is right for you

I too like to keep the scar off of the breast if possible and I feel the transaxillary or underarm incision is a very good choice. From this incision the implant can be placed under the muscle, or over, though we favor a submuscular implant because the capsule contracture rate is significantly lower.

Despite your surgeons fears the lower pole coverage will be satisfactory, and through the transaxillary approach the lower attachment of the chest muscle should be released as the muscle will cover only the upper 2/3 of the implant. The issue here is anatomy as the breast lies over and below the chest muscle. If the muscle in not released the implant will sit or ride up too high and spoil the result.

The question of "good" scar is an important consideration. I find it best to think of what you consider an "acceptable" scar. Some like the inframammary incision however the line will never tan and can always say "breast augmentation" in the wrong setting.

I suggest you stick with what you would like and look for a surgeon with the experience to provide it. There are many advantages to a transaxillary incision and the approach is safe and satisfying for patients.

Best of luck,


Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Thorough exam and evaluation for breast augmentation necessary

Thanks for your questions and points. It is imperative that you consult with a plastic surgeon that is experienced in breast augmentation. There are always advantages and disadvantages with any operation and this holds true for breast augmentation. A thorough examination and evaluation is required to determine what is best for you! I hope you find this helpful!

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

"Overs" or "unders" implant placement

This is a question that is repetitively asked for good reasons but has no answer.

Take it for what it is worth but I last heard that about 80% of surgeons prefer "unders".

Even the surgeon who made the transaxillary approach popular does not perform that approach in the vast majority of his patient's.

This is my simplified analogy without getting too scientific:

It is the surgeon's responsibility to make you aware of the risks and alternatives. The surgeon has to show you the "menu" of possiblities and they can make recommendations but ultimately you have to choose from the "menu" and accept the consequences of your informed decision. Ther is no right nor wrong choice, merely options.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Techniques of breast augmentation surgery

Every patient is unique and may vary in which option would be best for their particular or specific case. However, it does depend on the individual's body type, the size of the areola, and the internal anatomy as well. Most of the time, I recommend the peri-areolar incision. This incision is beneficial because the tissue of the areola is vry forgiving compared to the regular dermis. The scar tends to fade as a fine line incision over the course of time. As with any scar, the incision will fade but will never disappear. Placing the implants submuscularly, regardless of the patient's body type will prevent less risk of rippling and palpation of the implant. It's true that tisk of encapsulation is decreased as well. It also provides more support preventing sagging from gravity and aging.  I recommend consulting a board certified plastic surgeon to discuss the best and safest possible option for you. During your examination, the surgeon will suggest either saline or silicone implants depending on the amount of breast tissue you have to start off with and your body type. Silicone gel implants are considered the most natural feeling implants and are suggested for patients who have very little body fat percentage and the amount of breast tissue coverage to begin with. The transaxillary and tuba incisions are associated with more complications such as, malpsitioning, loss of sensation, assymetry, etc. However, surgeons specialize in different types breast augmentation surgery techniques. Consult a plastic surgeon and choose who you feel comfortable with. Good luck and take care.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 reviews

Best Breast Augmentation

I am not a believer of a full muscle coverage of the implant. I have seen numerous patients that have had that done only to see that their breast tissue has fallen over the implant and the implant appears to be sitting too high. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

I lean towards your position.

I prefer the under the breast incision for a number of reasons including good scar, excellent access, low complication rate, ability to precisely the implant, etc.

I place the implant completely under the muscle, and I invite you to look at my results (www.drkasden.us). There are things that can and are routinely done by myself to ensure optimum shaping of the final breast mound.

Finally, I strongly believe in the submuscular placement. It reduces riskes of cc, sagging, ripples. It doesn't however, guarantee that you will not suffer any of these complications, but it reduces them.

I would advise a frank discussion with your surgeon and decide if you have a basis to go forward together.


Scott E. Kasden, MD, FACS
Dallas Plastic Surgeon
4.7 out of 5 stars 101 reviews

Find a plastic surgeon whom you trust.

Hi! Ask to see lots of before and after pictures. Then let him do what he or she thinks is best. Don't tie the surgeon's hands. Maybe an axillary approach is not best for you. And I get great results putting implants over the muscle in the right patients.

The outcome in breast augmentation is NOT determined by whether you put the implants over the muscle or under the muscle or partially or under the fascia. And it is not determined by what implant you use. It is determined by the planning and the judgement and the good eye and the technique and the caring of the individual surgeon.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Each surgery needs to be individualized for each patient

There is not one right answer. The reason why there are so many different options is because different people need different procedures. Without seeing your photos or examining you, it is hard to tell for sure which is the best option for you. It sounds like your surgeon is giving you good and realistic advice. Good luck with your surgery.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

There is no such thing as best...

Breast augmentation is an imperfect operation. Each choice you make will affect the potential side effects and complications. Each patient and surgeon will have different opinions on the different characteristics of the breast as regards size, shape, texture, proportion, relative complications, etc. There are so many factors and variables to consider that one method or one result cannot be consider better or worse than another. A rippled result is no better or worse that a firm result. You should go over each options very carefully with your surgeon. In general, I believe a surgeon should be flexible in his approach to each patient since each patient brings a different set of goals and level of risk aversion to the operating room table. To say that one method or implant is the best is ignoring the multifactorial and imperfect nature of breast augmentation. your goal is to get the "best fit" procedure with the risk profile that you are willing to tolerate.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 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.