Help with Breast Augmentation Incision Decision

Happy Holidays! I am considering BA to fix my breast asymmetry (as much as possible) and enhance volume. I have consulted a few surgeons but I am still confused as to which incision will work better for me. A couple suggested periareolar (since I don't really have a fold) the other two suggested inframammary. I am of hispanic descent (if that makes any difference in regards of scar healing and such). What is your opinion? Would the transaxillary incision work for me at all? Thank you :)

Doctor Answers 34

Which Incision is Best for Breast Augmentation?

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Your breast asymmetry is mild based on this photo with the right breast being slightly larger than the left.  The incisions all have different advantages and disadvantages. Without going into an explanation of all of the advantages and disadvantages I will tell you my preference.

I would use a periareolar incision in your case because 1) your areola are a good diameter to accommodate a saline or silicone implant, 2) it gives me direct visualization of the entire implant pocket, and 3) tends to heal very well because that area is camouflaged between the dark areolar skin and the normal breast skin. The theoretical risks of periareolar incisions are nipple sensation changes and potential difficulty in breast feeding.

As for the trans axillary incision, the advantages are that there are no incisions on the breast. That's it. The disadvantages are: 1) If it heals dark, then when you raise your arms it will be visible, 2) If you need a revision you will most likely need an incision on your breast, 3) Unless it is done endoscopically, it is a blind pocket dissection and has an inherently higher chance of problems like bleeding and asymmetry.

Hope that helps and good luck!

Dr. Babak Dadvand

Los Angeles Plastic Surgeon
5.0 out of 5 stars 51 reviews

Incision choice in breast augmentation

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Incision choice is always a concern in breast augmentation.  If you scar well, it does not really matter.

 If you have a history of poor scarring, you have to think about where you would want your scar hidden.   Most sleeveless garments will show a armpit incision.   Some swimsuits will show an inframammary incision.   Some patients do not want thickened scar around their areola.

Generally, patients that scar poorly will choose the inframammary approach.  It is technically the easiest for your surgeon, allowing us to make any necessary adjustments in the safest fashion.   In addition, it is the approach of choice for any revision surgery.

I am yet to see a patient unhappy with an inframammary incision and think this will suit you best.

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

There Are Numeroius Factors That Can Affect The Incision Location In Breast Augmentation

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Breast implants can be put in through multiple incisional approaches as you know. The incision is not the important part of the breast augmentation operation, the breast implant is. The incision is just a way to get there and most breast implants can be put in through any of the available incisions for the most part. (exception of silicone implants through a small armpit incision) However, in patients with more skin pigmentation, the resultant scar from the incision may make a difference because it may be more visible if any  hyperpigmentation results from it. Because of your Hispanic ethnicity, the armpit (transaxillary) incision would be an excellent aesthetic choice if saline breast implants are acceptable to you.

Breast augmentation for asymmetry

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Most women have some asymmetry, and most plastic surgeons should be able to correct such asymmetries through multiple approaches.  I think that you should feel comfortable if your surgeon has explained the options to you, as well as what expectation you should have with each option.  I would feel comfortable with any approach/scar location. 

Jonathan Heistein, MD
Fort Worth Plastic Surgeon
4.7 out of 5 stars 29 reviews

Incision location

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The incision choice is multifactorial.  If you are having gel implants your areola may not be large enough to place them in that way .  The incision for transax would also be longer as well and possibly more noticeable.  Salien can go through any of the incisions.  Some approaches give better exposure than others.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Which incision is best for breast augmentation?

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Great question!

One of the most common questions that we get asked by our clients is which incision is the best for them.  In your case, your breasts are relatively symmetric and so you could really use any of the three incisions available to you. 

That being said, keep in mind that there is no perfect incision and this is not only a personal decision for you but also a decision that should be made with an experienced Board Certified Plastic Surgeon so that he/she helps you review the advantages/disadvantages of each approach. 

In my practice, I tend to use mostly silicone gel and favor the inframammary crease incision.  Over time it heals nicely, is well hidden, and I am better able to adjust any asymmetries I find during surgery.  I also rely on the use of sizers during surgery to help determine and bring out any asymmetry that is no apparent before surgery.  Think of it like trying on shoes; I can actually see the small differences that might not be apparent during the initial consultation.  Once I figure out which implants look best, I then open the permanent implants and place them through the Keller Funnel (to minimize trauma to the implant). 

I hope this helps and which you the best for your breast augmentation!

Breast augmentation

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The best approaches are inframmary and peri-areolar.  With silicone gel implants, infra-mammary would be the best, but per-areolar can be done as well.  If saline, then per-areolar approach for you (based on your photo), only because it would hide the scar better!  This is my opinion only!

Shahin Javaheri, MD
San Francisco Plastic Surgeon
4.4 out of 5 stars 6 reviews

Best Breast Augmentation Incision

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Thanks for the question.  You have several options for the breast augmentation incision as I am sure you were made aware of during your consultations. I prefer the peri-areolar incision, as it provides several advantages over the other incisions.  Additionally, the scar blends in the excellently with the surrounding breast tissue. Irrespective of which surgical approach your surgeon uses, you will in all likelihood have a favorable result if the procedure is performed by a reputable Board Certified Plastic Surgeon who has experience with breast augmentation surgery. I would encourage you to interview several physicians and ask to see the before and afters so you can get a better idea of what your scar will potentially look like.

Best of luck,

Glenn Vallecillos, MD, FACS

Glenn Vallecillos, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 30 reviews

Choice of incision for breast augmentation

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From the photo view I would say that the asymmetry is within normal variance and is best ignored. Implants only deal with volume asymmetry. 

The issue of incision choice is one that should be best made by the surgeon based on prior experience of the surgeon as well as others. Unlike choice of the implant type and implant profile which should be up to the patient, technical issues and experience count for far more on incision choice. 

I would argue that the consensus of experience has clearly come down in favor of the inframammary approach to incisions for implant placement. This incision only needs to be 2 cm for saline implants and 3-3.5 cm for gels (using an implant funnel). The advantages to the crease incision are: direct access to the space for the implant to allow for pocket creation under any conditions and without cutting through the breast, control of the inframammary crease level, and ease of return to the implant later on if ever needed or desired. The other incision choices all have drawbacks to these issues. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Breast augmentation with implants: incision and scar considerations

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AT this point in time the inframammary is the most popular fo several reasons. It is the most direct approach to under the muscle placement without transecting the ducts allowing the placment of a sufficiently lengthy incision for use of silicone gel filled implants. That having been said, in my practice, I am equally divided between the periareolar and the fold incisions. I sometimes favor the peri-areolar incision because it allows minor manipulations or lifts of the nipple & areola and is convenient to conceal a scar when there is no crease or fold. I use the axillary (armpit) approach occasionally but find that the scar can be more visible and have concerns about colonization and accurate placement as well as convenience of subsequent revision or replacment surgery.  

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 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.