What Would Determine Nipple Incision Vs. Under Breast Vs. Armpit Preference for a Person?

There are three
typical incisions for a breast augmentation as you mention in your question. In
general all three approaches can yield very good results for your
augmentation.

Some of the
factors to determine the approach are surgeon preference/experience, nipple
size, tendency to form scars. Most
surgeons have one or two ways that they commonly perform their breast
augmentation. You want your surgeon to perform
the surgery the way he typically does as they do it for a reason and are very
comfortable with that specific approach.


If then nipples
areolar complex is very small this approach may not be an option as the implant
has to fit though the incision. The areola skin border is a great place to hide
the incision as this natural transition of color will make the incision very
difficult to see once it has completely healed.


Under the
breast or IMF incision is very common as it is a direct approach and in the
majority of patients hides very well. In
patients with darker skin or a tendency to form thicker scars I tend to avoid
this incision as it may not hide as well as other methods.

The axillary
approach is great in that it avoids any scars on the breast. With the use of the endoscope the implant
placement can be very precise and a traumatic.
The natural creases in the axilla hide the incisions and are difficult
to find with time. Axillary endoscopic
breast augmentations do take additional equipment and training and thus not
everyone performs breast augmentations through this approach.

Please discuss
your breast augmentation with your board certified plastic surgeon.

from all the choices axillary (armpit) incision makes most sense. If possible (not for all women) this it the best, secure , safe and most predictable approach. It allows larger more beautiful breast without breasts scars. n rit hands it has minimal complication rate and predictable minimally invasive scars. For skille surgeons it is preferred way to perform breast enhancement 

Thank you for your question. All the incision placements are extremely safe. The periareolar incision does raise the risk, although still low, of changes in nipple sensation. It also requires more dissection through the breast tissue itself to get to the pocket in the breast where the implant will sit. It also puts the implant in contact with the milk ducts, which harbor a bacteria which can be a risk factor for capsular contracture. (I put a waterproof, clear, plastic dressing over the nipples during surgery regardless of implant placement to account for this.) One final factor in evaluating the periareolar incision is if you intend to breastfeed in the future. I tend to favor the inframammary fold incision, but I do perform all three common incisions.Good luck, and for more information about other choices to be made before undergoing breast augmentation, take a look at the Guide to Breast Augmentation on my website from the web reference below. I discuss common patient questions I receive, silicone versus saline implants, round versus anatomically shaped implants, smooth versus texturized implants, implant manufacturer, implant insertion incision location, implant location inside the breast, and more. 

There are currently three incisions used for breast augmentation surgery. These include the peri-areolar, trans-axillary and inframammary approaches. All three of these incisions have advantages and disadvantages when used for this procedure.When choosing an incision, most women's primary concern is scarring. All three incisions are associated with scarring to some degree, but the impact of this scarring is dependent upon the patient's lifestyle. For this reason, the incision should be based on the individual patient's needs. For instance, a trans-axillary approach might result in a highly visible scar in a sand volleyball player who brings her arms over her head and, therefore, may not be the best option in this patient.In the majority of patients, we prefer an inframammary approach. This incision is nicely hidden when wearing most types of clothing. In addition, it releases the muscles from the chest wall along the inframammary fold which allows for a more natural look.The choice of incision in most cases is decided by anatomic findings in combination with personal lifestyle choices. For these reasons, it's important to thoroughly discuss this issue with your plastic surgeon prior to surgery.

It really depends on the surgeon and the patient. Some prefer a particular incision. For example, I have found the inframammary incision to achieve the most accurate placing of the implants, however through the armpit can be great for someone who has a small nipple and undefined inframammary fold, making these other incisions difficult. Incisions around the nipple can increase your risk of developing breastfeeding difficulties or nipples sensation changes. You should speak with a surgeon to find out what is best for you.

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 transaxillary approach is very misunderstood.  It is much more difficult and technically demanding then directly accessing the breast through an infra-mammary approach or through the nipple.  This is the main reason that most surgeons think it is too difficult or frankly impossible.  In my opinion it just does not make sense to place a scar on the breast in an aesthetic elective procedure unless a lift is needed.  For primary augmentations with class I-II ptosis I exclusively use the transaxillary Cold-Subfascial Breast Augmentation TM.  What this means is that I access the interface of the pectoral fascia and pectoralis major muscle through the axilla (arm pit) and carefully dissect the fascia from the muscle.  The implant goes under the strong supportive fascia and above the muscle.  This is VERY different from "above the muscle" or subglandular techniques which typically do not fare well.  The fascia not only shapes the breast beautifully but the muscle is out of the picture allowing the breast implant to sit naturally more medially than dual plane techniques and it also offers the implant lasting support to prevent bottoming out and undesirable changes.  Live surgical videos have been published on the technical aspects of the Cold-Subfascial Breast AugmentationTM where the delicate dissection can be observed. 

Even the product representatives may believe that transaxillary placement is too difficult or impossible but these beliefs are remnants from early experience decades ago with saline transaxillary augmentation with a 2-3 cm incision.  The reality is that an endoscope it not necessary and the axillary incision heals and nearly disappears in most women and a larger incision in the axilla can be shortened and hidden with suture technique. 

I hope this helps,

All the best,

Rian A. Maercks M.D.

As you can see there are multiple ways and opinions on how to approach this. All have good points but for the record, I use underarm almost exclusively and I use the endoscope for most accurate control of the fold, AND you can use silicone implants, even up to over 500cc by using the Keller Funnel. I can change implants and do a capsulotomy and even add saline through the underarm. More important to find a good surgeon!

The most common preference for plastic surgeons is inframammary or "crease" incisions for a variety of reasons.  This is my general preference as well.


Most accurate pocket with lowest rate of implant malposition (creation of symmetric pockets is easiest through this direct approach)

Hides well

No breast tissue is divided (less likely to effect sensation or breast feeding than some of the others)

Easiest to control the shape of the lower pole of the breast in cases such as breast base constriction

Revisions can be done through the same incision, if necessary

Theoretical lower risk of capsular contracture from a more "sterile" incision site without axillary or breast duct bacteria

In the event the scar is not perfect it is in a hidden location


York Yates MD, Utah.

The choice of incisions  for breast implant placement is important to discuss with your surgeon as their experiences with each are valuable.  The choice is tied closely to the type of implant being placed, anatomy and patient preference, as is the choice of implants dimensions & volume.  Approaches through the nipple & arm pit are harder to do when placing gel implants (can't be compressed) and can give numbness in the nipple and inner arm respectively.  Under the breast and arm pit incisions are easily concealed.  Added advantages of under the breast and arm pit approaches is less dissection through breast tissue when using a below muscle placement, which may effect interpretation of future breast imaging.  Saline vs. silicone recommendations frequently are based on soft tissue/breast tissue coverage and yes, patient preference.  These are all topics that will be addressed during your in office consultation, where a physical examination will help focus the surgeon's recommendations.  Good luck!