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

Still in discovery and info stage of decision of doing this.doing this? Is it better for anyone one way or another? Dependig on size, chance of losing sensation in nipples or having hyper nipple sensation?, placement?, previous implants? What do I consider in making that choice?

Doctor Answers 17

Breast Implant Incision Site

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Breast augmentation incisions are placed strategically so as to be minimally noticeable once the incisions have healed. There are three incisional approaches that are commonly used: at the border of the areola (peri-areolar), in the underarm area (axillary) and in the crease at the bottom of the breast (inframammary fold). Each has advantages and disadvantages, and each is ideal for a particular kind of preoperative scenario.
Peri-areolar incision
This is made at the border of the areola, from about the 4 o'clock to 8 o'clock position. It works nicely for patients with larger areolar diameters (4.0 cm or larger), as if often the case after pregnancy and lactation. The color difference between areolar skin and breast skin nicely conceals the scar in most cases, and in many patients the scar is almost undetectable within just a few weeks or months of surgery. This incision truly has the possibility of producing a scar that is ultimately invisible or almost invisible.
A theoretical downside with this incision is that it by definition requires the division of milk ducts when the breast tissue is dissected down to the pectoralis major muscle, and this may interfere with future attempts at breast feeding. There are some who believe that this incision carries a higher risk for capsular contracture as bacteria may be present in the milk ducts which could possibly adhere to the implant surface during breast augmentation surgery, which may over time lead to contracture. The latter is a theoretical concern, and it has not been conclusively shown that the peri-areolar approach has a higher rate of capsular contracture than the axillary and inframammary fold approaches. The peri-areolar incision is therefore still frequently used, as the aesthetic outcomes are usually excellent.
Trans-axillary incision
This is the ideal approach for patients with very youthful-appearing breasts, who do not require correction of significant breast asymmetry or major alteration of breast shape (such as tubular breasts). When the breasts are small and perky, the inframammary fold is clearly visible and it therefore does not conceal a scar very well - and sometimes not at all. If the areolar diameter is small, then a peri-areolar incision is not practical. So patients with small, perky breasts and small areolar diameters are best served by an incision in the underarm area, also known as the transaxillary approach.
Placing an implant through this approach is technically more challenging and requires the use of an endoscopic camera and endoscopic surgical instruments. Make sure the surgeon who offers you an augmentation through this approach has a great deal of experience with it. The axillary incision must heal in a warm, moist environment, and it therefore takes longer to fade to the point that is difficult to see. Patients tend to be a bit self-conscious about raising their arms above their head while wearing a swimsuit for the first six to nine months after surgery, but by one year postop most have a scar that is difficult to discern even on close-up examination of the underarm area.
Inframammary fold incision
This is the most commonly used incision for breast augmentation in some practices, primarily because it is the quickest and easiest approach. It is a reasonable approach to use for patients that have fuller, more pendulous breasts, where the lower pole of each breast hangs over the inframammary folds somewhat and will tend to conceal a scar placed in this area. It is not a great choice for a patient with very perky, youthful-appearing breasts where the inframammary folds are clearly visible, and will remain clearly visible postoperatively.
Another problem with this incision is that even when breasts are full in the lower pole and somewhat pendulous, there is nothing to conceal the scar when a patient lies down and the breasts fall off to the side somewhat. If a scar in the inframammary fold heals with some widening and/or hyperpigmentation, it can be rather obvious. This incision should therefore be reserved for patients who have small areolas and who would benefit from a breast-area incision in order to correct significant asymmetry or other problems with breast shape (or who simply prefer to not have the surgery performed through the axillary approach).

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

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

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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.

Breast Augmentation Incision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

While all three are acceptable, I find that:

1) all scars typically heal well, but...

2) Under the breast (in the fold) is one the patient almost never sees, whereas the other two they may

3) Under the breast is more versatile (you can't put silicone in through the other two always)

4) Under the breast is often needed in any future surgeries

So obviously my bias is under the breast.  Also, the only person who ever sees that scar is someone with whom you are topless, and that is usally a very small number of people.  (Whereas the under armpit may be visible in a bikini or sundress).

Michael E. Decherd, MD
San Antonio Plastic Surgeon
4.9 out of 5 stars 61 reviews

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

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for the question. There are several good approaches to breast augmentation surgery; different surgeons will have their own preferences.  In my practice, I prefer the inframammary or infrareolar approach for most patients.

 Despite what you may hear, I think most patients can have the infraareola incision used regardless of the size of breast implants or size of areola. The Keller funnel has made the insertion of all sizes of breast implants much easier.  I think of the funnel has also made it easier to perform a true "no touch" technique ( potentially decreasing the incidence of breast implant encapsulation).
Personally, I think the advantages of the infraareolar incision far outweigh any theoretical disadvantages. These advantages include proximity to the planned dual plane submuscular pocket dissection, relatively hidden/forgiving location of scarring, coverage by clothing/swimming suit etc.
Best wishes.

Transaxillary or Armpit Breast Augmentation is my preference for all primary cases without ptosis

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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.

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

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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!

John J. Corey, MD
Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

Incision choice for breast augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 189 reviews

How about beautiful breasts without scars on the breasts?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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 

All Incisions Are Very Safe, But Periareolar Does Raise the Risk of Changes in Nipple Sensation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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. 

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.