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

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!

   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

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

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.

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