Breast Implant Scars

I want larger breasts but I'm afraid that the scars will be obvious when I wear a swimsuit. Where and how big would the scars be if I got breast implants?

Doctor Answers 176

Scars for breast augmentation are usually hidden in your swimsuit

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Breast implants are inserted through a variety of incision options:

1. In the fold under the breast (inframammary)
2. Around the areola (periareolar)
3. Through the areola and around the nipple (transareolar)
4. Through the armpit (trans-axillary)
5. Via the belly button (trans-umbilical)

The inframammary fold (IMF) incision preserve the function of the function of the breast, namely breastfeeding and pleasure. I use this incision most commonly for breast augmentation surgery.

When an incision is made in the fold under the breast, the scar lies in a natural crease and does not tend to stretch or be raised, as can happen in other areas. All structures leading to the nipple and areola (milk ducts, nerves, blood vessels) remain intact. In addition, once an implant is inserted, it is probable during a woman's lifetime that another surgery may be required (to change the implant, remove it later in life, perform a breast lift with drooping, etc.). Therefore, the scar is already present and this can be used again as an incision in the future.

Many other incisions used for breast augmentation are only a one-time option, with the IMF incision required in the future. The IMF scar is hidden in bras and even triangle-top string bikinis, and will only be visible up close when the breasts are lifted.

Peri-areolar incisions are usually around the bottom of the areola, the pigmented circle that surrounds the nipple. There are bacteria that live in this area, and vital milk ducts and nerves in this region. By definition, some of these structures will be divided (cut) during surgery, resulting in a higher risk of complications (infection, numbness, inability to breast feed, etc.). In addition, if a woman makes raised scars, they may be visible beneath a tight shirt or through a bathing suit.

Trans-areolar incisions also cut through breast tissue and/or ducts, blood vessels or nerves. Nipple retraction can also result from scar tissue that normally forms after surgery. For these reasons, I would not recommend this for most women.

Trans-axillary breast augmentation makes an incision in the armpit, or axillary area. This is often a one-time incision, that creates a scar in the area where most women shave, and is also a site of normal bacterial growth (hence deodorant use!). The incidence of infection can potentially be higher, and this incision cannot be reused in the future for addition other surgery.

Trans-umbilical breast augmentation (TUBA) is more of a gimmick than routine approach. A long tube and scope with a camera must be tunneled beneath the skin of the belly button all the way to the area under the breast. If there are any complications during surgery such as bleeding, or if the surgeon cannot adequately visualize what they are doing, a second incision must be made in the IMF. Only a tightly rolled up saline-filled breast implant can be used (not silicone implants), it is also a one-time incision, and a long band of scar tissue beneath the skin is possibly visible after surgery - a permanent deformity. I would never recommend this option to any of my patients.

San Francisco Plastic Surgeon

Breast Implant Incision sites and scars Natural Looking Breast Augmentation

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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.

The infra-mammary fold incision works very nicely for patients who do not have a marked color difference between areolar skin and breast skin, and who have adequate fullness in the lower pole of the breasts. As full breasts conceal the infra-mammary fold very well, the scar is usually not visible when standing or sitting upright. Ideally this scar is placed just above the inframammary fold on the lower pole of the breast, so that it faces down and therefore tends to be less noticeable.

Breast implants can be inserted through a limited incision in the belly button area, however there are a number of problems with this approach and it therefore is not widely used. Approaching the surgery from such a remote location does not lend itself to the creation of a precisely-defined implant pocket, or the creation of a natural-appearing result.

Most women concerned about scars are hoping to achieve a natural-looking result from breast implants. Please educate yourself about implant size and positioning to help ensure the most natural looking breast implants possible.

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

Breast Implant Scars for Large Implants Should be Under the Breast

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The best access to place very large Silicone Gel Breast Implants is the Inframammary Incision which is placed near or in the crease below the breast. A larger incision can be well hidden underneath the breast to allow for a very large Breast Implant. If you are having Saline Implants any incision can be used because the Implant is placed inside deflated and then inflated once inside.

There are many things you can do to improve your scar after Breast Implants-see the link below.

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Hiding Breast Implant Scars

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The good news is that scars are usually so well hidden after breast augmentation that very few women have concerns or difficulties with their scars!

Incision scars for breast implants can be hidden and the choice of incision placement involves trade-offs:

  • In the breast crease: Incisions in the breast crease can vary from 2cm (about 3/4-inch) for saline implants up to 4cm (1-1/2 inch) for the largest silicone implants. Because the saline implants are filled after they are placed into the breast, a smaller incision is needed. The scar is positioned just above the crease (~1/4-inch) so that it will not show if the bottom of your swimsuit top rises up a bit. 
  • At the edge of the areola: This would eliminate fears of the scar showing when you wear a swimsuit. There is a slightly higher  rate of capsule contracture and loss of nipple sensibility with this incision. These incisions are generally about 1-1/4 to 1-1/2 inches in length skirting the edge of the areola.
  • Armpit incision:  While this takes the scar away from the breast, the scar may be apparent when you raise your arm. These incisions are generally 1-1/2 to 1-3/4 inches in length.
  • Belly Button incision: Few surgeons perform this approach because it is so remote from the breast and the long distance tunneling from the belly button predisposes for more imperfections in the appearance of the breast augmentation. Because an endoscope is used for this approach, the incision is about 1/2-3/4 inch inside the upper edge of the belly button.

The appearance of the scar is an important consideration and be sure to discuss your concerns and preferences with your surgeon.  Find out what your surgeon suggests to hide your implant surgery incisions.

Breast Implant Scars, Location and Size

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Scars should never be obvious when you wear a swimsuit, and only if done in the underarm would they even be barely visible. Scars are kept to a minimum length in my practice, just sufficient to make the pocket.  For saline implants this can be as short as 2.5 -3.5 cm. or 1.0-1.5 inches. Incisions are repaired very securely with slowly absorbing sutures so there is no worry about the incision coming open in the healing process, and there are no sutures to remove.

In the past, a gel implant required a larger incision than a saline implant.  The saline implant comes deflated and can be placed through a 2.5-3.5 cm incision. However, a gel implant comes fully filled from the manufacturer, so one must imagine the full size of the new breast fitting through the incision. The larger the implant, the larger is the required incision. In fact in the past, implants in the 400 cc or larger range required incisions of 4.5-5.25 cm or larger. The reason the incision had to be longer is because one cannot force an implant through an incision that is too small. In the first place, the implant will simply not go through the incision, and secondly, the manipulation required to gradually introduce the implant could traumatize the implant shell, possibly leading to early implant failure.  The usual procedure is to make an incision of adequate length, and then if there is any significant resistance at the time of insertion, to stop, remove the implant and slightly lengthen the incision.

For patients requesting gel implants, I always now give them the option of using a Keller Funnel, to get the smallest possible incision.  This innovation in breast augmentation surgery allows placement of gel implants through incisions that are often as small as the incision required for saline implants.  This depends on the implant size, but since most women have implants of 400 cc or smaller, most women can have their implants placed through an incision length of 3.5-3.75 cm, the same as saline implants. You can read more about the Keller Funnel at their website.

The result is a shorter scar and minimal handling or trauma to the implant regardless of incision location.  The incision location is an individualized decision made in consultation with the patient based on her anatomy, location preference and consideration of trade-offs and advantages with each incisional approach.  Since I offer a choice of all incision locations, patients make their own choice after consideration of the pros and cons associated with each.

The "Scarless" Breast Augmentation

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Breast Augmentation surgery does not have to leave a scar on your breast. I do all of my primary Breast Augmentations through an axillary (armpit) incision. The incision under the arm in general heals very well because there is no tension on the incision while healing. The other 2 popular incisions are periareolar or infra-mammary. The infra-mammary incision is very visible and in my opinion should be avoided completely.

Bernard A. Shuster, MD, FACS
Hollywood Plastic Surgeon

Breast enhancement, breast augmentation, breast implants

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Breast implants can be placed through a variety of different incisions, however the most direct approach is through the crease underneath the breast. This approach offers the best view for the surgeon to develop the pocket for the implant. Bleeding can easily be controlled, and the implant is not traumatized by being pushed through a tunnel from the armpit or belly button. Post-operative scar massage and topical bandaids made with medical grade silicone can help the scars fade very nicely in most patients.  The scar should sit just above the crease so that it is not visible in swimwear.

Patti A. Flint, MD
Scottsdale Plastic Surgeon

Implant scars

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Your best bet would be to schedule a consultation with a Board Certified plastic surgeon and discuss your concerns at the time of your consultation. There are several options with regards to where the incision for the implants will be made. The scars can  be hidden well enough so that no one would notice them when you are wearing a swim suit.

Scars with breast augmentation

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Every operation leaves a scar. This means that if you have breast implant surgery you will be left with a small scar. There are 4 ways of putting in a breast implant. One way is to put the scar in the belly button. This technique can only be used for saline implants placed above the muscle. The most common places to place the scars are around the lower edge of the nipple areola, under the breast in the bra crease or in the armpit. All of these techniques leave a scar which is usually a faint white line about 2cm long. Recently in our clinic we have begun using the Keller funnel which allows us to place a cohesive gel implant through a scar which is very small as the scar seen when using saline implants.

Breast Implant Scars (Scarless Breast Surgery?)

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Breast implant scars can come in a variety of different sizes and locations.  Individual anatomy and desired size will have a huge impact on the answer to this question.  The size of a scar depends on the size of the implant and the type of implant used.  Generally speaking incisions are smaller for smaller implants and for saline implants.  Saline implants are filled after they have been placed inside the body and therefore can be placed through smaller incisions unlike the prefilled silicone implants.  Scar size is also impacted by the potential need for a mastopexy (breast lift).  This generally involves scars around the nipple and potentially down from the breast (vertical lift or lollipop scar) or even under the breast (anchor or wise pattern). 

More important than the length of the scar is the location.  Three areas the incision is generally performed include: the arm pit (axilla), around the nipple (periareolar), or under the breast (infra-mammary).  Incisions on the breast generally heal very well and can be difficult to see with time.  There are many advantages and disadvantages to each incision location.  There is no such thing as scar less breast augmentation the scars are generally hidden by the location but still present.

Axillary incisions are in an area that is often seen in bathing suits either when laying out or playing in the water but because they are not on the breast it is possible that a lay person would not realize that scar was used for an augmentation.  The desired size of augmentation can be more limited by this incision location as it is hard to get a large implant all the way down to the breast.  This incision is the furthest from the breast and the operation can be more difficult and less predictable but a really good choice for patients who do not have a well-defined crease under their breast. Scar length generally 4-6cm long.

Periareolar incisions (around the nipple) put the scar on the focal point of the naked breast which could be seen as a disadvantage but his portion of the breast is always covered in bathing suits so no one would ever see the scar unless you were topless.  The main disadvantage to this incision location is the potential contamination of the implant by the breast duct fluid which can have bacteria in it.    Scar length generally half way around the areola

Infra mammary incisions (under the breast) put the scar in a location that the patient cannot see without a mirror.  A well placed scar sits just above the natural fold of where the breast hits the rib cage.  This lower portion of the breast is virtually always covered by any normal bathing suit.  When naked the scar is difficult to see from a front on view.  The scar is most apparent when viewed naked and from below.  General this point of view is seen by someone who already knows you have had breast implants.  Scar length generally 4-6cm long.

All breast augmentations are not the same and an individualized treatment plan should be made with your anatomy and goals in mind.  The only way to know what your specific scars would look like is through a private consultation.  I hope this helps.

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.