Incision dilemma. (photos)

I have decided to undergo breast augmentation using Natrelle round implants dual plane technique under the muscle. Size most likely 250-275 on the right and probably 300-325 on the left to even them out. Sizers will be used during surgery for best results. Only dilemma I have left is the incision. With my dark completion, living on the beach& preferring topless tanning ( in a year) I can't decide what incision is best. My dr feels comfortable with both, decision is mine& I can't make one .

Doctor Answers 7

Breast implant incision

Dear Ava. From the photos you are at a great starting point and should expect a very nice outcome. It seems the big decisions have been carefully thought through and made and it is great that you are so engaged in the process. However, I think the choice of incision should be made by your surgeon - go for whichever he/ she has the most expertise in. My own preference is for an inframmary fold incision - it is associated with the fewest complications. Good luck!

London Plastic Surgeon
5.0 out of 5 stars 53 reviews


My preference is the go peri areolar. The incisions are well concealed when they heal and the surgery and implat placement is controlled. I use a funnel so the incisions are smaller. 

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


I usually go periareola( under the border of the areola) or inframammary. It really depends upon the size of the implants and the size of the areola.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Incision choice

I prefer under the breast or inframammary.It is amenable to pressure post op to minimize scar and gives the surgeon better visualization of the pocket.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 62 reviews

Incision dilemma.

Thank you for the question. Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery. In my practice, I prefer the use of the infra areolar or infra mammary incisions for most patients.

Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.

I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Breast augmentation Incision dilemma.

Good results may be obtained with both types of incisions depending on individual anatomy, a patient's concerns and desired outcome. There are pros and cons of each.

Periareolar: The incision which goes around the edge of the dark areola that surrounds the nipple (usually the lower half) is used to insert the implant.
The scar usually blends wells well with the surrounding tissue.
• The same incision can be used again if later surgeries are needed.
• The space for the implant can be seen clearly with direct vision.
• The incidence of infection after surgery may be minimally greater.
• Breastfeeding in the future may be interfered with in some but not in most patients.
• Nipple sensation may be decreased, but it is usually temporary.
• While the scar usually blends in at the edge of the areola, there is also a chance it
could be lighter or darker than the adjacent tissue.
• If the areola is too small, the incision may not be a good option for larger silicone gel implants.
• Potential slightly higher risk of capsular contraction.

Inframammary: The incision is placed at the bottom of the breast near the crease called the inframammary fold.. This is the most commonly-used incision today.
• The same incision can be used again if later surgeries are needed.
• The space for the implant can be seen clearly with direct vision.
• Slightly lower risk of infection.
• While it is a visible scar, the position underneath the breast in the fold means it is
usually not visible while standing without clothes.
• Potential slightly lower risk of capsular contraction.
• The scar can be visible on the breast when lying down.
• Placement higher or lower on the breast will make the incision visible.
• If there is a secondary procedure to place a larger implant, the scar may be located higher on the breast. If a smaller implant is placed, the crease may be raised, exposing the scar in a lower position, possibly in view under a bra or swimsuit.
• Longer appearing incision than around the areola.
• May not blend in as well as a periareolar scar.

Keep in mind that following the advice of any surgeon on this or any other web site who proposes to tell you what to do without: examining you, physically feeling the tissue, assessing your desired outcome, and taking a full medical history, as well as discussing the pros and cons of each operative option would not be in your best interest. I would suggest that your Board Certified Plastic Surgeon be certified by The American Board of
Plastic Surgery who is ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person. That way, you can have a better idea what is safe and makes the most sense for you.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

Incision dilemma.

All incision options of the 4 (infra mammary, circumareolar, axillary, umbilical) have potential notioceable scarring. Best to decide and use every scar remedy available.

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 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.