What would you recommend; incision through the nipple or under breast?

Hi I'm 5'3" about 116pds. Looking into doing BA sometime this fall. What would you recommend more, incision through the nipple or do under breast? I don't like scars even if they're small. But at the same time, I hear going through the nipple hurts more and healing time is longer. Can you please give me your input on this. Thanks!

Doctor Answers 20

BA incisions

The incisions used to place breast implants are periareolar (on the light dark border of the areola) and inframammary (beneath the breast in the fold). The majority of plastic surgeons throughout the country use the inframammary incision. This incision allows surgeons to avoid going through breast tissue and lactiferous ducts as well as excellent visualization of the implant pocket. Use of the inframammary incision has a slightly lower incidence of capsular contracture as well. Good outcomes can be achieved with both types of incisions, healing time is roughly the same and each plastic surgeon will be able to describe the incision they use and the reason for their preference. 
Make sure you seek consultation with a reputable board certified plastic surgeon to discuss your concerns and goals. 


Portland Plastic Surgeon
5.0 out of 5 stars 15 reviews

Recommended incisions depend on a lot of factors

and this includes your desire to breast feed, accept risks for contractures, implant style and type, whether you may need a lift in the future and what kinds of swimsuit tops you like to wear.  But if you want the safest approach, it is always under the breast.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Choices

Thanks for your question.  Both choices are reasonable. Suprisingly, the incision below the breast ( in the crease) is very well-concealed and cosmetically appealing.  Good luck. 

Breast Augmentation Incisions

Hello,Periareolar incisions are associated with the highest rates of capsular contracture, as well as having their own unique complications associated with violating the breast tissue, from skin to muscle. Inframammary incision have the lowest risk of capsular contracture, and don't violate breast tissue. As for aesthetic outcome, despite popular belief, inframammary incisions produce less conspicuous scars than periareolar incisions. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Breast Augmentation/Breast Implants/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision

I appreciate your question. The size of implant best for you is dictated by your chest wall measurements.  Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance.  Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.   Silicone will give you a fullness at the top (upper pole fullness).  Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion. Anatomic gummy bear implants might be a good choice to give you volume.  These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak. During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery. Best of luck! Dr. Schwartz Board Certified Plastic Surgeon Director-Beverly Hills Breast and Body Institute #RealSelf100Surgeon

Around the areola or under the breast - which is best?

The most common incisions are around the bottom of the areola (‘periareolar’), in the fold of the breast (‘inframammary fold’ or ‘IMF’), or in the armpit (‘axilla’). There is no ‘best’ incision as each incision has advantages and disadvantages. For example, normally, only saline implants can be placed through an axillary incision. When considering periareolar vs in the fold one must consider whether to use saline or silicone – for example, a large silicone implant can not be placed through a small areola. I would suggest a formal consultation with a board-certified plastic surgeon so your specific concerns can be gone over in detail, a physical exam be performed, and individualized recommendations be made. Good luck!

Periareolar or inframammary incision

Thank you for your question.  The choice of incision depends on multiple factors.  For example, if you have a small areola, an inframammary incision might be better especially if you're getting silicone implants.  Silicone implants are pre-filled and require a slightly larger incision.  Also, inframammary incisions have a slightly lower risk of capsular contracture.  Otherwise, the periareolar incision is an excellent option as it heals very well at the border of the areola for those who have favorable scar healing.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 16 reviews

Incision type for breast augmentation

The inframammary incision (in the breast crease) will leave a scar approximetely 1 to 1 1/2 inches long depending on the technique and the surgeon. It is only seen if one were to lift the breast up and look under it. It does not penetrate the breast tissue or the ducts, so breast feeding should not be a problem. In addition, some surgeons feel there may be a slightly higher incidence of a firm capsule formation and/or infection with the periareolar approach (around the nipple). The periareolar incision is at the border of the skin and the areola, so it is much less visible. Loss of nipple sensation can occur with either approach, as it has more to do with the pocket and the size of the implant than the cut in the skin.

Gustavo E. Galante, MD
Schererville Plastic Surgeon
5.0 out of 5 stars 52 reviews

What would you recommend; incision through the nipple or under breast?

I hope you don't really mean going through the nipple, that's a very deforming scar that, to my knowlege, was abandoned years ago. If you mean going along the lower margin of the areola, that is an excellent choice for many patients. In an augment, the muscle is the painful part, it doe not matter where the skin incision is, the pain and healing are the same. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Either fine

I'm favorable to the periareolar approach because it camouflages the scar well in our patients. Also, precision implant placement is possible when operating centrally 

Stuart A. Linder, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 40 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.