Which is the best incision site for my breast augmentation? Concerned about the loss of sensation or hyper-sensitivity.

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.  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.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.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.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.  

It does not make sense to put scar tissue on a breast. Armpit incision is a wonderful scar-free option for breast augmentation. Silicone implants can absolutely be inserted through the arm-pit, don't let anyone tell you that is not an option. There are few reasons for an incision under the breast or through the nipple. The scarring under the armpit is minimal, look at the attached video. Don't let doctors not comfortable with the approach talk you out of it. Transaxillary is the standard in Asia and the UK and the results are completely natural. Patients are so happy not having to deal with any types of incision or scarring on the breast. 

This is a good question as the majority of patient that wish to have a breast augmentation desire a result that is going to feel and look natural without having obvious scars.   



There are several ways to place the incision so that it is well hidden in natural skin folds or breast transitions. 





Periareolar



Hidden at the natural transition from the areola and the breast skin.  The incision can be hidden in this natural color transition.Secondary surgery can easily be performed through this incision.Inframmary Fold



The incision is hidden in the fold below the breast.Secondary surgery can be performed through this incision.Axilla



The incision for the implant can be hidden in one of the natural axilla folds. 



Using the Keller Funnel allows for placement of silicone implants in a variety of sizesPlacement is very precise with the use of the endoscope.Umbilical



This technique has become less popular as only saline implants can be place using this method. Also patients run the risk of destroying the fold, which can cause their implant to drop overtime.It is important to see your board certified plastic surgeon to help guide you to an implant that will give you an aesthetically pleasing breast.

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 approachThe degree of visual and surgical control your surgeon will haveThe 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 bacteriaYour preference regarding the final location of the scarSize of the implantThe 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)ProsSurgeon has direct vision of the breast pocket and more surgical control reducing chances of breast tissue damage, implant damage, bleeding, and complications like asymmetrical breastsThe implant can be placed “under the muscle” or “over the muscle”Any type of implant can be inserted using this incision siteCritical nerves and blood vessels are unlikely to be damaged reducing the chances of changes in nipple sensationThe scar could be well-hidden within the crease of the breastsThis technique allows the ’bloodless’ techniqueConsAlthough the scar would be hidden under the breast, it may sometimes move onto the breast, worsening the aesthetic looksThis approach is not suitable if there is areolar asymmetry or areolar herniationIt is less desirable in patients who have glandular tissue asymmetry which requires reshaping of the breast tissueWho 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 implantsTransaxillary (within the armpit)ProsThe Incision will be hidden within the armpitThere is less damage to the breast tissues while dissecting an implant pocket compared to the periareolar approachWith proper technique the rate of capsular contracture is low relative to other sitesNo muscle is cut, the implants simply slides into a natural sub-muscular spaceRelatively quick surgery, shortest time under anesthesiaConsThis 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 malpositionIf a revision surgery is ever required, it is more difficult to do it through the axillary incision and a new incision may be requiredThe surgeon will be limited to place the implant behind the muscleWho 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 implantPeri-areolar (through the dark pigment around the nipple)ProsUseful 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 areolasProvides your surgeon direct vision during pocket dissection and good surgical controlAllows easier correction of areolar/nipple asymmetriesConsThe 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 optionsIf 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 supplyDuring 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 techniquesWho 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 valuableNow 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.

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.

The incision around the areola may increase the risk of developing sensation changes. If that your biggest concern, then you may want to opt for a different incision placement.

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!

   The best incision site is based upon a number of considerations.  If you want saline and the least amount of scar, then transumbilical augmentation provides the best choice.  This approach also tends to have lower risk of hematoma and infection.  You must be hernia free for this approach.  This also has a low risk of nipple areolar sensitivity changes. 

      The periareolar incision is reported to have the greatest compromise to the sensitivity.  Some areolae are too small to allow placement of large implants. 

      The IMF incision is good for most things because it is easy and the scar is well concealed in women with lower breast pole fullness. 

        The transaxillary approach can be performed if you have a hernia and cannot perform transumbilical.  There are many, many other considerations that I can sort through in a few seconds of the physical exam and help you decide.  Please find the board certified plastic surgeon with ELITE credentials who performs hundreds of breast augmentations each year.  Kenneth Hughes, MD Los Angeles, CA

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

All incisions have some risk of reducing sensation in the nipples.  The risk does seem higher with incisions under the areola as a lot of the nerves that provide sensation are in this area. 

In my practice, my preference is for the transaxillary endoscopic approach, which uses an armpit scar.  Sometimes we encounter some of the nerves that give sensation to the breast but these can be easily preserved.  Almost all patients preserve sensation to their nipples when we use this type of incision.