Which is Better and Less Painful, Armpit or Aerola Incision?

My doctor wants to use the aerola, but I was thinking the armpit would be less evasive. How long can it be until the breast can be touched in either case? What is the recovery time for each? I want to return to normal life as soon as possible. It will be silicon under the muscle about 400 cc's. I weigh 112 lbs and 5 '6" tall.

Doctor Answers 13

Which is Better

If one incision were really better than others, there would only be one and all would use it. When the incision is on the breast, it is quite uncommon for the patient to have incision related pain, though there is implant related pain.   When the incision is under the arm, there is added discomfort since the arms are not stationary. 

The recovery time will not be different. Choose the incision with your surgeon based upon where you want the scar, and discuss with your surgeon whether he/she feels that one or the other incision is less likely to result in problems with positioning.

Thanks for your question, best wishes.

Armpit or Areola for Implant Placement

   In general, the risk for infection and capsular contracture may be greater for armpit and areolar incisions for different theoretical reasons.  I prefer the transumbilical, MF, or periareolar for saline and the IMF or periareolar for silicone.  The pain is due to placing the implant under the pectoralis major muscle, and I do not think any of these incisions is necessarily less painful.  Kenneth Hughes, MD Hughes Breast Augmentation Los Angeles, CA

What is the best point of entry to place breast implants during surgery?

Hello,

Thank you for your inquiry.

The 400cc silicone implants inserted from the armpit will result in a fairly visible a scar in the axilla with a higher chances of CC due to possible bacterial contamination. 

As for the insertion from around the areola, another visible scar will be placed at the point of entry. However, this method may be beneficial if you have decided to have a circumareolar (doughnut) lift.

Finally, the inframammary insertion may be the best bet in terms of aesthetics and low infection risks.

I encourage you to communicate your concerns and thoughts with your surgeon before your surgery so both of you would be on the same page.

I hope this helps and the best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 186 reviews

Breast Augmentation Incsions Definately Have Pros and Cons

Great question!  The armpit or trans-axillary incision's main advantage is that it is hidden in the armpit, far from the breast and not visible even without clothing.  The distance from the pocket is an issue so only saline implants rather than pre-filled silicone implants are typically used.  The peri-areolar incision heals fairly well and can be used for either saline or silicone implants.  It is usually not a very painful incision but it can be associated with a higher risk of loss of nipple sensation or hypersensitivity.  The inframmmary incision is well hidden in the fold of the breast, allows either a saline or silicone implant to be used and the risk of nerve injury is fairly low.   The umbilical incision has the same advantages and disadvantages as the trans-axillary approach.  Additionally, special instrumentation and experience is required.  If there is bleeding with any of the remote incisions, an inframmmary approach could be required to address it.  Please take an extra moment to discuss your concerns with your surgeon as well as the pros and cons of each technique.  If you are going to use silicone implants, a peri-areolar or inframammary incision seems most prudent.  Good luck!

George Bitar, MD
Fairfax Plastic Surgeon
4.7 out of 5 stars 48 reviews

Incisions

The correct incision is the one that is best for your anatomy. There is some degree of discomfort regardless of the site used.You will have arm and breast pain with the axillary incision.

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

Which incision for breast augmentation

You ask an interesting question.  I do a lot of axillary incisions. I have found the scars to be virtually invisible when all is said and done.  Of course if the surgeon is using this approach, they should use the endoscope to do the surgery.  I agree with the other comments that the incision will need to be a little larger with silicone implants, which come pre-filled.  The largest silicone implant I have personally placed through the armpit was 450cc.  Also, if surgery for a leaking implant is needed in the future, there is a good chance that the crease incision will be needed. Recovery should be about the same with either incision. Since all of us differ a little in our approach to post-op care, the details need to be discussed with  your surgeon.  Good luck!

Paul W. Loewenstein, MD
Milwaukee Plastic Surgeon
4.8 out of 5 stars 26 reviews

Armpit incision for breast implants sounds appealing, but usually it is not the best choice.

There was a time about 20 years ago when the armpit approach was quite popular.  But its popularity has waned for several reasons.  First of all, while you don't have a scar on your breast, you do in your armpit and this can sometimes be visible (hairdressers, volleyball players...).  Most women eventually have subsequent surgery to replace implants or treat problems and these are usually done using an inframammary incision, so now you have four scars rather than two.  Plus, the armpit approach is more difficult for the surgeon: asymmetry is more likely and it can be a challenge to get the cleavage just right (and it is equally invasive).  I'm not sure one approach is more or less painful than the other.  I think all submuscular procedures are probably about the same in terms of pain.  A periareolar scar is also a good option, as recommended by your surgeon.  You don't want to insist that your surgeon use an approach that he or she is not comfortable with or uses infrequently.  Recovery to full activity is about a month regardless of the approach used.  Breasts can be touched right away.  Steristrips on incision usually come off in a week.  There are some examples of inframammary approaches on my website and periareolar (J.S.); the scar is nicely hidden in the crease.  A link is attached.

Eric Swanson, MD
Kansas City Plastic Surgeon
4.7 out of 5 stars 46 reviews

Incision choice with breast augmentation

Cupcake, 

There is no evidence that one incision hurts more than another in breast augmentation or that one heals faster than another.  Each approach has advantages and disadvantages.  I would suggest that you discuss this with your surgeon and think carefully about what he feels would work best in your situation.  

Keep in mind that in a sleeveless top, your axillary incisions will be noticeable.

In two to three weeks, you will be back pretty much to a normal lifestyle.

Best of luck to you,

Douglas Hargrave 

Best incision for breast implants

HI,

 

There is not a great deal of difference in post operative pain from different incision sites following  breast augmentation surgery. 400 cc silicone implants are fairly large implants and will be more difficult to place through a trans-axillary approach. There is recent evidence that implants placed through either the armpit or peri-areolar approach have a slightly increased risk of post- operative capsular contracture due to small amounts of bacteria located in the glands of the skin of those regions, and thus I recommend an infra-mammary approach for you. The new breast crease is also very effective at hiding the incision.

All my best,

Daniel  A. Medalie, MD

Which incision is better?

Thank you for your question. I use any of the three surgical approaches for implant placement (transaxillary, periareolar, or inframammary) depending on the needs and desires of the patient. For moderate sized silicone implants you might want to consider the inframammary approach as the longer incision required for these implants (compared to saline implants) may be less likely to lead to nipple numbness (periareolar) or a visible scar in the axilla. There is not a significant difference in recovery with any of the approaches as the limited incisional tenderness is not really noticed compared to the feeling of tightness most women experience. Generally all of the scars heal well, its more a matter of the possible consequences of the location of the incisions. All the best!

Scott A. Brenman, MD, FACS
Philadelphia Plastic Surgeon
4.9 out of 5 stars 37 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.