does the incision site make a big difference in how your breast will look? & does above or under the muscle effect your outcome?

I'd really like an transxillary incision but I'm afraid of spacing out. but does a periareolar or inframmary incision make a big difference in your results? besides the visible scar itself. and also I had a consultation with a doctor and recommended id go above the muscle vs under due to the shape of my breast...does anyone know why? and will this decision effect my results? I'm 21 5'4 110 pounds 32b/c

Doctor Answers 11

Breast Augmentation: Information

Dear Ms. Beautyxkills,

Thank you for your story and questions. Unfortunately without nude photos and a actual
exam I am limited (including taking accurate measurements of your chest) and thus can only give you (hopefully helpful) non specific comments.

Choosing the correct breast implant is a multifactoral depending on your anatomy, skin strech, desired look and size.

Breast size is a very personal choice and using a variety of techniques (some of which you may have completed) you can achieve the size and look you desire.

Unfortunately bra manufactures have not standardized cup sizes.
Breast implant manufactures have created a wide spectrum of implants based on a "cc" measuring system. Different base widths result in different projections for the same size of cc's. Different shapes are based on the cohesiveness of the internal gel.
My responses are:
A)purchase several bras (full bodied and no padding) of the size you think you want to
be. As you realize there are no standard bra (strap/cup) sizes.
B)take a measuring cup (1 oz=30cc) place rice in a nylon y
C) try on various volumes of rice with some form fitting clothes.
D) if implants placed in the submuscular position I personally add 10% additional volume to compensate for the muscle flat renting of the implant.
2)placement of implant:
Select several nude model photos of the goal breast shape you desire.
Placement decision of implant(subpectoral, dual plane, or suprapectoral) will be determined based on your anatomy If the implant is placed under the pectoralis muscle I usually add 10% volume to what the patient chooses.... to compensate for the muscle pressing down on the muscle and for the naturally settleing of the implant which often makes the breast appear smaller 2-3 months after surgery.
3)profile of implant:
A) for the same volume the higher the profile the narrower the base width.
B)there is very little difference in projection between a moderate to high profile implant
thus little affect on the perceptible final projection of your breasts.
C) the base width of the breast should equal the base width of the implant
D)thus I personally chose the profile based on the patients chest measurements,
(a high profile on a wide chest may not result in the cleavage desired and
conversely a low profile on a narrow chest may result in implant in the outside arm
4)types of implants:
A) round
B) anatomical or shaped be (form stable)
5)Filler material
A) Silicone gel
B) Normal Saline
6) Access incisions
A) axillary
+ no scars on breast
- scar in armpit
B) Peri areolar
+ blends with areolae
- higher chance of internal scarring (capsular contracture)
C) intra mammary
+ lowest incidence of internal scar ting (capsular contracture)
- scar on breast
E) umbilical
+ no scars on breasts
- can only insert saline filled implants
7)there are four companies that produce breast implants:
-1) Mentor
-2) Allergan
-3) Sientra
-4) Ideal
1-2 =silicone fill comes from same factory
3 =silicone gel has highest cohesiveness (gummy bear) for round implants
1= only implants made in USA
1-2 = make both silicone and normal saline filled implants
4= only makes normal saline filled implants
4 = has internal baffles in normal saline implant to give feel more like silicone filled implants
1-4 = all FDA approved, lifetime warranties
1-3 have capsular contracture warranty
1-3 have different profiles (for same volume different base widths) resulting in different projections.
1-3 have anatomical or shaped implants.
I personally use all four companies based on the above and the best "fit" for the patient.
I trust your Plastic Surgeon is experienced and is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

My best wishes and success,

R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Riverside Plastic Surgeon
4.8 out of 5 stars 99 reviews

Incision site for Augmentation

Yes the incision does make a difference. I prefer the nipple or the inframammary scar as these are hidden and allow me to use precision to make the pocket so that the implant sits in the perfect location. The axillary incision can take some time for the implants to fall in my experience. I would advise to go below the muscle. Gives you better coverage of the implant and less chance of palpability and or visibility of the implant. From your pics I can see you like a saline or high profile gel look.  I recommend either saline or the SRX Allergan Inspira implants.  These are the ultra high profile that will look great. 

Look for a Board Certified Plastic Surgeon.  Good luck!

Andrew Cohen, M.D.

Andrew T. Cohen, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 44 reviews


The incision site certainly makes a difference in the outcome. There is significantly more control over the surgery with the infra mammary and peri areolar incisions than the axillary. Using a funnel makes these scars much smaller. Capsular contracture is less with the submuscular placement

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

Breast augmentation incisions

The incisions for breast augmentations do not change the shape or outcome, although I prefer the axillary approach because the scar is imperceptible.  In my opinion, when the implant is over the muscle, there is a more natural appearance.

Malcolm A. Lesavoy, MD
Beverly Hills Plastic Surgeon
3.9 out of 5 stars 11 reviews

Does the incision site make a big difference in how your breast will look? & does above or under the muscle effect your outcome?

My best advice based on 30 years of experience performing breast augmentation is to find a plastic surgeon whom your comfortable with, avoid extreme sized implants and for a better chance of long term good results have the implants placed beneath your pectoral muscle.  For implants that are not excessively large I find that a transaxillary incision works well.  If your areolae are large enough and you wish to push the implant size more aggressively I would recommend avoiding an inframammary incision due to the scarring and to use a periareolar incision.  Please watch the video above for some information about the negatives of too large an implant over time.  Best wishes.

Jon A Perlman MD FACS
Certified, Am Board of Plastic Surgery
Extreme Makeover Surgeon ABC TV
Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

Does the incision site make a big difference in how your breast will look? & does above or under the muscle effect your outcome?

Transaxillary incision is associated with a slighter higher risk of capsular contracture and implant  malposition based upon several studies. Subglandular augmentation is also associated with a higher risk of capsular contracture vs sub-muscular as well as increased rippling and visibility of the implant edges. All incision sites generally heal well.

Richard Chaffoo, MD, FACS
San Diego Plastic Surgeon
4.8 out of 5 stars 23 reviews

Incisions and implant location

Incision - 

A transaxillary incision is a great way to hide a scar but you are limited in the size or shape of implant that you can fit to keep the scar small and hidden. The other incisions are commonly used as well. Inframammary allows the most freedom in changing the size of the scar to accommodate a bigger implant and for more direct access to the pocket where the implant will be placed. Periareolar incisions have a higher risk of bacterial contamination and resulting capsular contracture but some patients prefer the scar in that area. Your results will depend on your anatomy and your surgeon picking the incision type that he or she is most comfortable with using to achieve that results that you want. 

Implant location-

An implant above the muscle is a good option if you have enough natural breast tissue to cover the implant and blend the contours to your chest to have a more natural slope and shape. Implants below the muscle are better covered and reduce the chance of rippling and capsular contracture. Implant movement may be more noticeable when you flex your pecs at the gym or in any activity using the upper body. There are also various dual-plane techniques which share characteristics of both locations.

Discuss your overall goals and possible concerns with your plastic surgeon to come up with the best incision and implant location to create the results you are looking for. 

Johnson C. Lee, MD
Beverly Hills Physician
5.0 out of 5 stars 14 reviews

Breast Implant Placement & Incision

Thank you for your question, for the majority of my patients, I recommend under the muscle placement with silicone implants for a more natural look, with a lower risk of complications. One of the few situations where I recommend going over the muscle, is if the patient is a body builder and competing in a lot of shows where the pectoralis muscle is flexed. In that case, the muscle is very active and one gets a lot of animation with the implant. For either placement, there are circumstances based on a patient’s anatomy that one may be more beneficial than the other so it is important to be examined by a plastic surgeon to make an informed decision.

In terms of incision, the periareola incision is typically the most concealed, because the incision is made along the outer edges the darker area of the areola. However, this method involves cutting through the breast tissue to get to the pocket for implant placement, possibly severing nerves and milk ducts. This increases the risk of change in nipple sensation. There is also a higher risk of capsular contraction, which is when scar tissue forms around the breast implants and causes the breasts to harden. There is a risk that if the scar does not heal well, the scar may appear raised or lighter color than the areola, a look that may be more obvious than one may prefer. The inframammory incision is the most common type of incision and is hidden in the breast fold. Though this type of incision is less concealed than the periareola, a bra, bathing suit, and often the breast itself can hide the small 3-5cm scar. There is less risk of capsular contraction, and nerve damage. Also this incision allows for the most control over the placement of the implant meaning the results are more likely to be symmetric and consistent. I most often recommend the inframmamory incision for patients who have moderate breast fold allowing for the scar to be naturally concealed and for patients with small areolas looking to significantly increasing the size of the breasts.

Again, it's best to discuss all your options with a skilled plastic surgeon to find out what is best for you. Good luck!

Kamran Azad, MD
Pasadena Physician
5.0 out of 5 stars 13 reviews

Best Breast Augmentation INCISION and Over or Under the Muscle Implant Placement?

Everyone has strong opinions on BOTH the Best Breast Augmentation INCISION and Over or Under the Muscle Implant Placement.

The best incision is the one that is the most unnoticeable and which allows the surgeon to modify the breast pocket and place and ideal implant NOT only this time but also in the future, years from now, when the this implant ages and leaks.  A good Plastic surgeon should be able to use all incisions BUT certain breasts do better with certain incisions.

Choosing THE BEST breast implant is NOT based on internet (photoshopped) images but on how much breast tissue you have now which can cover the implant. IF the implants are not covered by your tissues, their shell and their shell ripples can be felt and seen from the outside. For this reason, although we physically CAN put larger implants in many women, we choose NOT to because we know they would end up with large, artificial breasts with ripples. As a result, we often use the UNDER the muscle location to hide the rippling and provide a smoother contour to the breast.

Your board certified Plastic surgeon should be able to take you through this and pick the implant which offers the best compromise of volume, shape and contour.

Good Luck

Peter A. ALDEA, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 109 reviews

Implant position

 In my opinion, if the skill level of the surgeon is the same for each of the chosen incisions, then it shouldn't matter about implant position based on which incision is used. I have found that the transaxillary incision, while it's very good for the first placement of implants, I find it difficult to do anything but enlarge the pocket should something have to be corrected thus necessitating another  incision. For ethnic skin, I think the incision is more hidden around the areola than in the crease. Sometimes in the face of a very large implant choice, and a small areola, the inframammary crease may be better. With a dual plane positioning, I don't see much advantage even in the shape of the breast by placing it in the sub glandular position. We find that the capsular contracture rate is less under the muscle and wrinkles are less obvious. One can release enough muscle medially as well as lift the gland off the bottom of the muscle such that the bottom of the pocket would replicate what it would be if it was on top of the muscle. Discuss these options with your plastic surgeon. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 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.