What is the Best Place to Insert the Implants for Breast Augmentation? (400 CC Saline)

I have finally chosen my doctor and have scheduled my surgery for Christmas Eve :) When Dr.Kim initially asked where I wanted to do the incision I chose around the areola, but now I am thinking about the armpit..I just want to make sure there are no side effects and which is the best, I also chose for the implant to be placed under the muscle.

Doctor Answers 16

Choices for insertion of breast implants

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As you have indicated there is no best choice for access to the breast and insertion of the implants. This will vary depending on patient anatomy and surgical indications. The transaxillary incision is a great choice for the right indications.

New York Plastic Surgeon

Breast implant incisons and placement

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experienced plastic surgeons should be comfortable and experienced with all approaches

transaxillary,  periareolar, submammary, and TUBA  (belly button)


saline is easily done through TUBA  one incision ,, invisible

silcione do well through the armpit..  hard to see


choose wisely

dr H

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Transaxillary Breast incision

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If you have picked your plastic surgeon, which it seems that you have, you should use the incision that he feels most comfortable with.  You want to be routine on the day of surgery.  Many surgeons have not been well trained to do the Transaxillary approach, and so they poo poo it, and well they should because they are not familiar with this approach.  Having the largest series reported in the literature, having done more than 2,000 transaxillary breast augmentations, there are a number of things that have been told you that are wrong.  

1.  the transaxillary incision does have the least chance of loosing nipple sensation as the dissection is furthest from the nerve to the nipple.  The Periareolar incision has the highest chance as the dissection is closest to the nerve.

2.  In my series of revisions 64% of the time, you could use the transaxillary incision for a revision.  Of course this wont be that high if the surgeon is not familiar or comfortable with this incision in the first place.  You can not do a capsulectomy through the transaxillary approach.

Good luck with your surgery!

This article is in the Aesthetic Surgery Journal in the September 2011 issue.

Dan Mills, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 35 reviews

What is the Best Place to Insert the Implants for Breast Augmentation? (400 CC Saline)

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There is no "best place" to insert the implants, only alternatives with advantages and disadvantages.  Established pros and cons may or may not materialize in your situation.  Surgeon preference is important, your body and breasts, whether or not nipple sensation and breast feeding are important to you, and other factors.  Submuscular placement best, in my opinion, for saline implants because of additional soft tissue camouflage the muscle offers.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Incision for breast augmentation

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The incision choice for breast augmentation is multifactorial including your preference, your anatomy, the size of the implant, revision or primary to name a few.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Incision choice for breast augmentation

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Thanks for the question. First of all, I agree both with. The size as well as the sun muscular placement.  I am not, however, a fan of going through the armpit for a few reasons.  There is a higher incidence of asymmetry and sometime the implants end up too high.  Also, if you ever need further surgery, it is hard to do a revision through the armpit.  I would suggest the periareoalar incision.  Good luck!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Location of breast implant incision

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As you can tell from the answers to your question, there is no one answer that is right for all patients and all surgeons. Surgeons have their preferences based on their experience and patients' anatomy can make also make one approach better than another. I would only add that the armpit scar is potentially visible whenever you raise your arms while wearing something sleeveless. Depending on where you live and what you wear, this can be a concern. Good luck to you.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

Preference for breast augmentation incision - infra-mammary for me

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Given the issues with increased rate of capsular contracture using peri-areolar approach and issues with implant malposition using the axillary approach - my preference continues to be the infra-mammary incision. With good planning, the scar can be placed in the breast fold, where it is virtually invisible between aesthetic subunits. I disagree with others that recommend a 'belly button' incision to their patients - not a great surgical approach for a variety of reasons.

Incision location for Augmentation

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The choice of incision is up to the patient and physician comfort. Armpit incision can be more difficult then areolar or inflammatory incisions. Patients choose a site based on their concern for visibility of the scar. the outcome of the augmentation is not effected by the location of scar if the PS is comfortable with that approach. But certain chest shapes are not a good candidate for arm pit incisions, ask your PS what his feelings are about incision location.

Shahriar Mabourakh, MD, FACS
Sacramento Plastic Surgeon
4.9 out of 5 stars 227 reviews

The best augmentation incision is where you want it to be

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You can have an excellent breast augmentation through a transaxillary, inframammary, or a periareolar approach. The choice depends on your preference and skin type, and how well you think you can conceal the scar while healing. We like the underarm approach quite a lot though some surgeons are not as comfortable so ask your surgeon if he has a concern.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 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.