Where Do You Normally Put a Breast Augmentation Incision for Darker Skinned Patients?

I'm torn between what incision I want! I'm scared of scarring bad. I'm a tanned filipina, more brown than yellow and I did have my heart set on the under the armpit incision but I was told theres a possibility that "the gap" may be too wide, and that there's a higher risk of complications. I'm considering going under the crease, since it's right at the pocket. What incisions do you suggest most on your Asian clients?

Doctor Answers 25

Dark skinned breast augmentation patients often choose axillary or arm pit incisions

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In my practice African-American patients who choose Breast Augmentation and are worried about Keloids or bad scars choose the axillary or arm pit incision. This way if they do develop a keloid scar it is well hidden. The areolar scar, if keloid would be very visible.

The preferred incision for breast augmentation in dark skinned patients

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The most common incisions used across the country are the inframmamary( underneath the breast) and the periareolar( along the lower end of the areola .In patients who have a higher propensity to have thickened scars such as African-American, Latinos and Asians and who have very little breast tissue I tend to use the periareolar incision because it usually heals very well. The inframmamary incision can also be used especially if the breasts are not too flat so that the incision is better hidden. But if silicone implants are used, where the incision needs to be larger then I much prefer the periareolar incision. I tend to stay away from the axillari( underarm) incision beacuse of  a higher chance of needing revisional surgery.

Best breast augmentation for darker skin

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For patients with darker skin we like the periareolar incision the most as there is a natural color transition in the skin, keloids don't occur, and you can wear very little to cover the area. We avoid an infra-mammary scar if at all possible, and our second choice is under the arm. With skill there should not be complications with this approach, and the implant can be positioned quite accurately as with  any other technique.

Best of luck,


Underarm Breast Augmentation For Darker Skin

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It is very important to choose the breast augmentation incision carefully if you have dark skin and a history of making darker scars.

The last place that you would want a dark scar is under the breast where it will stand out against your smooth chest skin, especially with your arms over your head.  I would never want to take that chance.

The areolar incision is an acceptable choice, because the areola is already dark and the incision can be just inside it's perimeter.  But, it's still "front and center" and the focal point of your breast, and it is never my first choice for that reason. 

The axillary incision will be on a crease in a fold and will be least likely to show.  However, let's say you have very smooth skin in your underarm, and you like to wear sleeveless tops, and perhaps you dance a lot where your underarms would show.  Now the decision may lean toward around the nipple.

A good surgeon always puts a lot of thought into these details, and talks these things through with the patient, so that we make the right decisions together for your particular needs and concerns.

Gregory Diehl, MD, FACS
Long Island Plastic Surgeon

Breast augmentation scars

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A bad scar such as a keloid is problematic whether it is on your breast or in your armpit. There are a number of factors that have to be taken into account when deciding on which approach to use to place breast implants. Given the limited information in your post in the absence of photos or a face to face examination it is impossible to say which approach would be best in your case.

Even if the implants are placed via the armpit at some point in time they will have to be removed or exchanged for newer implants. The incision for that surgery will have to be made on the breasts themselves.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Breast augmentation incisions

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Both inframammary (near the crease) and periareolar scars tend to heal well.  No one can ever predict with 100% certainty how any scar will heal, however, and if you are concerned about how the scar may appear, an inframammary scar is usually concealed beneath the augmented breast while a periareolar scar is near the focal point (nipple) of the augmented breast. 

Good luck.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board-certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.


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Darker skinned individual generally do better with an incision placed at the areolar cutaneous junction.  It is not uncommon for inframammary and axillary scar to remain dark for a long time.  However areolar scars can appear lighter than the surrounding skin color.  There are no guarantees with any approach.  You are smart to explore all your options.

Scar Placement for Augmentation

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The other two options for incision placement and subsequent scars are just above the fold beneath the breasts or at the juncture of the areola and breast skin.  They both tend to do well over time, but if you are especially concerned about visibility of the scar, I would opt for the inframammary incision.  The advantage to this incision is the fact that there is color difference already present.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Placement of scar for Augmentation

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I would want to know if you have any history of hypertrophic or keloid scarring?  Have you had other operations, stitches and how have these healed?  Although no guarantees, it can give us an indication of how  you may heal.  I have used incisions around the periareola, inframammary crease and directly on the breast of Asians and African Americans.  I allow the patient to be actively involved in the decision discussing the pros and cons of each incision and risk of scarring.  Obviously a scar in the crease is more "hidden" than a scar directly on the areola in most situations.  Sometimes there is no perfect answer and you have to make the best decision you have given the information you have.  I can't make the decision for you.  Your surgeon will guide you based on their experience and what they feel is best for you given your specific situation.

Albert Dabbah, MD
Boca Raton Plastic Surgeon

Transaxillary or periareolar

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A transaxillary incision is often preferred and my patients have experienced high rates of satisfaction regardless of what their skin shade is. Many Asian patients also get the inframammary or peri-areolar incision placement. The key is to follow your surgeon's care instructions closely to minimize the risk of obvious scarring. You can also consider scar treatments, such as silicone gel and sheeting, which can help.

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.