I have small nipples and a small chest. What would be best approach?

Hello thank you for your question. Sometimes surgeons style and technique can vary. There are several types of approaches for where to make the incision. Given the size of the implant and that it is silicone will limit where you can place the incision. You can do peri areolar or IMF. Some surgeons can also do transaxillary approach (through the armpit) leaving no scars on the breasts. Everything else is a personal preference based on your anatomy and the look you are going for. Of course without a proper physical examination it is difficult to assess and give you accurate advice. You should seek in person consultation with your plastic surgeon.

Thanks for your question! I prefer the inframammary incision. Right now, you think you may be able to see it because you are relatively flat-chested but once the implant is in, that 3cm incision will hide under the breast nicely. Good luck!

Good afternoon!
I think you are an excellent candidate for breast augmentation, and 400cc HP through a nipple incision sounds awesome- that is the way I would place them for you! My second choice would be a crease scar, but it is a little more visible than the nipple incision. I believe your areolas are large enough for the placement of 400cc as long as your surgeon feels confident in their ability to do so!

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

I generally do not prefer the periareolar approach to breast augmentation. There’s a higher risk of capsular contracture, problems with the nipple (sensation loss, necrosis, widening,etc), and more difficult to create an adequate pocket. In your case in particular, it might be difficult to place a 400cc implant through a small incision.

I’d recommend an inframammary fold approach. With a 400cc implant, there would be some droop and the scar would be hidden in the fold. These scars also tend to heal quite well. There are less complications with this approach as well.

Personally, I perform a hybrid breast augmentation, with internal bra, modified dual plane, and fat grafting. This gives a stable, “braless” cleavage.

Thank you for sharing your question. You are starting from a good position and should anticipate a very nice result. I agree with you that your areola looks too small for that approach and I would recommend a breast crease incision instead. Hope this helps.

Hi and thanks for your question. You are a good candidate for breast implant. I recommend round implant with dual plane technique for you. Round implant can give a more natural result with upper pole fullness for your case. You have not enough breast tissue, because of this I recommend dual plane technique for you. In this technique upper part of implant is covered by chest muscle and breast tissue, lower part of the implant is covered by breast tissue. With this combination you can get good result. This operation takes 1.5 hours and can be done under the general anesthesia. You should stay one night at the hospital to get rid of the anesthetic drugs affect. After surgery you should use sports bra and breast band for 6 weeks. Two weeks after the surgery you can start sports but you should wait for 6 weeks to use your arm strongly.

Dear vanessaroseerum,
I tend to prefer the periareolar incision because its the most well hidden. There is a natural border between the areola and the rest of the breast skin the hides the incision extremely well. You have to be completely naked to see it vs other incisions like transaxillary and inframammary are visible in clothing such as sleeveless shirts and bikini tops when extending your arms up. I've also noticed increased rates of bottoming out with inframmary incisions that is not reported. Transaxillary implants are always wide in appearance because the surgeon is not able to dissect medially enough to provide better cleavage. Ultimately, I can perform any of the incisions but I recommend the periareolar. There is no difference in sensation because the nerves that control nipple sensation come in laterally from the back and injury to them occurs when surgeons dissect to far laterally which is why transaxillary incisions have the highest nipple sensation disruption. There is no difference in breast feeding ability. One study did show a slight increase in capsular contracture with use of periareolar but that study was small and did not incorporate modern techniques such as below muscle placement, keller funnel usage and triple antibiotic irrigation.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I appreciate your concerns, and each of the three incision options for placement of implants has both pros and cons.
If your board-certified plastic surgeon is confident that placement of those larger implants through a smaller infra-areolar incisions is possible, then there should not be an issue, but explain that if there is any doubt of that ability, then a different approach might be considered. Inframammary incision hiding the scar within the fold of the breast is an excellent option with few drawbacks. Discuss all aspects of your surgery with your surgeon. Best of luck.

In my hands, I would use the incision under your breasts. I do not use the axillary incisions because of the higher risks and difficulty reusing this incision. Please discuss this with your surgeon.