Breast Augmentation Incision Sites?

I am concerned about how to decide which is the best incision site for my breast augmentation. Is one incision type more inherently risky than the others? One of my biggest concerns is loss of sensation or conversely hyper-sensitivity in the nipples. Any help is greatly appreciated.

Doctor Answers 18

Breast augmentation incision sites?

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!


Scottsdale Plastic Surgeon
5.0 out of 5 stars 17 reviews

Best Breast Implant Incision Site

Thank you for your question. Be sure to see a Board Certified Plastic Surgeon for advice.

Choice of incision site is a very personal decision made by you. Generally these are important things to consider:

  1. Best visibility for your surgeon for accurate placement and careful surgical technique is the Inframammary Crease-underneath the breast. These scars are well hidden.
  2. Transareolar-through the Areola is a well camouflaged scar. However it can disrupt milk ducts thus I do not use this in women who plant future pregnancy. It is best for the sagging or ptotic breast.
  3. Transaxillary-Through the "arm pit" does hide the scar very well. However it is a "blind procedure" meaning the surgeon cannot see the site of dissection to create the pocket. In my experience revisions are more commonly required to correct asymetry following this approach.
  4. Trans umbilical-Through the Belly Button. Requires a Saline Implant and manufacturer warranty is voided-enough said.

Breast incision types - pros and cons

Hi Terri. Thank you for your question!

Choosing the right incision site is important to get the best results.  When deciding the incision you have to consider the following things:  
Your surgeon’s skill and comfort level in a specific incision approach
The degree of visual and surgical control your surgeon will have
The ability of the incision to provide access to create and dissect a surgical pocket without much damage to the surrounding tissues (e.g., nerves and blood vessels), and appropriate insertion of the implant.
Degree of exposure of the implant to your own body’s bacteria
Your preference regarding the final location of the scar
Size of the implant


The Main Goal should be to choose an incision site that will minimize scarring, allow safe creation of the breast pocket, and safe insertion of the implant.

There is no incision site that is best for all patients and the decision must be tailored to your breast characteristics in collaboration with your surgeon – So what are your options?

The majority of surgeons offer 3 options and each has its pros and cons:

Inframammary (under the breast)

Pros
Surgeon has direct vision of the breast pocket and more surgical control reducing chances of breast tissue damage, implant damage, bleeding, and complications like asymmetrical breasts
The implant can be placed “under the muscle” or “over the muscle”
Any type of implant can be inserted using this incision site
Critical nerves and blood vessels are unlikely to be damaged reducing the chances of changes in nipple sensation
The scar could be well-hidden within the crease of the breasts
This technique allows the ’bloodless’ technique

Cons
Although the scar would be hidden under the breast, it may sometimes move onto the breast, worsening the aesthetic looks
This approach is not suitable if there is areolar asymmetry or areolar herniation
It is less desirable in patients who have glandular tissue asymmetry which requires reshaping of the breast tissue

Who is it for?
The inframammary incision site is best suited for patients who have a small areola (dark pigmented skin around the nipple), and those who require large implants or form-stable implants

Transaxillary (within the armpit)

Pros
The Incision will be hidden within the armpit
There is less damage to the breast tissues while dissecting an implant pocket compared to the periareolar approach
With proper technique the rate of capsular contracture is low relative to other sites
No muscle is cut, the implants simply slides into a natural sub-muscular space
Relatively quick surgery, shortest time under anesthesia

Cons
This procedure requires that your surgeon is well experienced in this technique as it is a “blind procedure” meaning your surgeon will be unable to see the site of dissection to create the breast pocket and if your surgeon is not skilled, it will require revision surgery for complications like breast asymmetry and implant malposition
If a revision surgery is ever required, it is more difficult to do it through the axillary incision and a new incision may be required
The surgeon will be limited to place the implant behind the muscle

Who is it for?
The axillary incision approach is most suitable for patients who have great concerns about having a scar on the breast and those who have a small areola, and require a small silicone or saline implant

Peri-areolar (through the dark pigment around the nipple)

Pros
Useful to avoid a scar in the fold of the breast. This is especially true if there is distinct border and color difference between the areolar skin and the surrounding breast skin. – it is a great way to hide the scar on patients with dark areolas
Provides your surgeon direct vision during pocket dissection and good surgical control
Allows easier correction of areolar/nipple asymmetries

Cons
The implant type and size that can be inserted is dependent on the diameter of your areola as we do not want to damage the implant – This limits your implant options
If your areola is not large, it will limit your surgeon’s visual and surgical control.
This incision requires dissection directly through the breast tissue which may cause changes in nipple sensation and may prevent you from milking normally unless your surgeon takes great care to not damage the milk ducts and blood supply
During insertion, the implant has a higher risk to be exposed to bacteria inside your breast tissue holding higher rates of infection and capsular contracture – This can be avoided if your surgeon uses the “No touch technique” using a Keller Funnel.
Risk of capsular contracture and nipple insensitivity is increased compared to the other techniques

Who is it for?
If you are someone with a large and dark areola, and are not planning on breastfeeding or having children in the future, then this option is valuable
Now regarding your concern of loss of sensation or hyper-sensitivity, it is important to realize that all incisions have some risk of in reducing sensation in the breasts/nipples. I do agree that the risk may be higher with peri-areolar incision as there are many nerves in the vicinity of the site.
The risk is also higher with larger implants that can press against sensory nerves near the breast tissue resulting in numbness.
Occasionally, breast sensation actually increases making it uncomfortable upon touch.
Fortunately, the changes in sensation are usually temporary, and everything returns to normal within a year or sooner.

In the end, for comprehensive information, you must consult with a board-certified plastic surgeon about your goals, concerns, and expectations.

Martin Jugenburg, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 371 reviews

Best Incision For Breast Augmentation

Having used all of the incisions over the past 15 years, I have settled for the most part on the incision under the breast.  

With gel implants being used much more commonly now, let me add that it is much more difficult to manipulate or re-position the implant once it has been squeezed through any incision that is far away from the breast. 

Also, in the case of future surgery to work on the implants again, you will likley have to have the incision on the bottom of the breast done anyway.

John LoMonaco, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 242 reviews

Breast Implant Insertion Locations

Generally there are four breast incisions that are used to place implants.  Like any thing in life, there are pros and cons to each site.  Discuss with your Board Certified Plastic Surgeon which incision is best for you.  Nipple sensation changes have been associated with all incisions.  The size of the implant has more to do with nipple sensation changes than does the incision site.  

  1. Inframammary fold incision (IMF) - Probably the most common site for breast augmentation is the U.S.  This incision is placed directly in the fold under the breast.  It allows good visualization for the surgeon and is well hidden.  The rate of capsular contracture is lower versus the periareolar incision.
  2. Periareolar incision - This incision is placed under the areola where the areola meets the skin.  It can heal very well and be almost imperceptible at times.  However, if it does not heal well, the scar is directly on the front of your breast.  The rate of capsular contracture has been shown to be higher with this incision in studies.
  3. Axillary incision - This incision is placed high in the axilla.  The good thing about this incision is that there are no incisions on your breast.  The bad thing is that when you have on a sleeveless dress, shirt or swim suit, you may be able to see the incision.  Both saline and silicone implants can be placed through this incision.  Large silicone implants become more difficult to place from the axillary incision.  The use of an endoscope can make this procedure more precise.
  4. Umbilical incision (TUBA) - The umbilical incision is used to place a saline implant from your umbilicus.  The good thing is that there are no scars on your breast.  Only saline implants can be placed through this incision.  
Thank you for your question.  

Incision

The best incision for you is the one that best fits your needs and will give you the best outcome. Your surgeon should be able to advise you well.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 14 reviews

Site of incision for breast augmentation

Dear Terri,

Thank you for your inquiry.

Usually, 4 main sites of incision are considered with breast augmentation surgeries:

1. IMF (inframammary fold) incision.

2. Circumareolar incision.

3. Axillary incision for trans-axillary implant insertion.

4. TUBA (trans-umbilical breast augmentation).

Depending on the type of implants chosen (silicone vs saline) as well as the size of the implants (especially with silicone) that the size and the location of the incision are determined. For example, if a patient is to consider a 600cc gel implant via a trans-axillary insertion vs a 200cc one then the patient is to anticipate a larger incision at the axillary region with the 600c implant than the 200cc!

Infection wise and development of capsular contraction seem to be the lowest with the IMF point of entry and the incision is fairly hidden at that area without any limitations applied to the size of implants the patient desires to have.

That being said, please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of additional corrective surgeries dramatically.
I hope this helps and please feel free to check the website below.

The best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 185 reviews

Breast augmentation incisions

I do not think incision site affects nipple sensation.

Incision site is strictly patient choice. The armpit incision hides with arms down, but is visible if you raise your arms in anything sleeveless. Augmentation through the armpit incision may have a higher incidence of implants staying higher.

Breast surgery incision

The incision really does not impact the sensitivity according to reports. It is a matter of basic anatomy, size of implants, type of implants, and personal/patient preference.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 23 reviews

Breast Augmentation Incision Sites? Nipple sensation

Dear Friend,

 

GIven your concern regarding nipple sensation I think you would be better off with a inframammary incision.  These are relatively small 4cm incisions placed along the IMF.  Once the implant is inserted the incision will sit right at the base of the breast (high enough ) so you can wear your two piece with no visible incision. Really a great approach to breast augmentation.  

Mary Ella Carter, MD
Washington DC 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.