For a first time breast augmentation, what incision site is recommended for someone who has never had kids? (photos)

I'm 5'2" and currently an A/small B cup, but would like to have a D cup and I'm planning on getting 450 CC's silicone. Since I've never had children before and I'm only 26 years old, I will probably have multiple surgeries during my lifetime. For my first breast augmentation, what would be the most ideal incision site and would this site be the same one my revisions would be done through? What are the risks of the periareolar VS the inframmary techniques?

Doctor Answers 23

Incision for breast augmentation

The three commonly discussed incision sites for breast augmentation (BA) include inframammary, periareolar, and transaxillary.  Every plastic surgeon has his preferred incisional approach, knowing there may be an occasional need to adjust or use an alternative incision based on the patient's anatomy.

I prefer an inframammary approach.  The incision is concealed along your breast fold.  The incision allows direct access to the inferior attachments of your pectoralis muscle to create a under the muscle pocket for the implant.  Additionally, the inframammary incision has the least bacteria present when compared to the other options.  Any type of implant can be placed through this incision.

Based on your photographs, I feel you would be an excellent BA candidate.  

I wish you the best,

R. Clark Mooty


Lubbock Plastic Surgeon
5.0 out of 5 stars 18 reviews

Incision Site

There are 3 different incision sites: inframammary, periareolar, and axillary.  It is your choice to a point, depending on the size of the implant with the silicone implants the periareolar and axillary may not be an option.  The inframammary is most common giving you best placement of the implants and the incision is still hidden in the fold of your breast.  

Discuss your options with your surgeon to decide what is best for you.

If you would like more information regarding breast augmentation and the incision options you can download a free copy of  my breast augmentation planner at ABetterBreast.com.

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 250 reviews

Incision Routes

Hello,

Thank you for your question. The IMF incision site is a popular choice for good reasons but the peri-areolar and Axillary routes may also be an option for you depending on your surgeon and your Implants.

I recommend that you book a consultation with a board certified Plastic Surgeon to discuss your aesthetic goals and options. They will examine you and make recommendations for incision route and for breast implants.

All the best

Breast Augmentation Incisions: Options

Dear MissV_801,

Thank you for your questions and photos.

There are advantages/disadvantages of all access incisions:
1)Peri Areolar access incision
+
incision blends with pigmented areolae
revisions can be accomplished
-
limited length of incision (larger silicone implants difficult to place)
slightly higher rate of long term capsular contracture

2) inframammarry
+
lowest chance to developing long term capsular contracture.
incision length not limited (can extend as necessary)
revisions can be accomplished
-
scar on breast

3)axillary
+
no scars on breast
-
if revision needed difficult to use this incision
scar in axillae
technically more challenging
Limited size of larger silicone implant

4) umbilical
+
no scars on breast
-
can use only normal saline filled implants
impossible to use this incision for revisions
sometimes large incision around umbilicus
need special instruments.

I trust you have chosen a experienced Plastic Surgeon who is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

I suggest you discuss your questions with your Plastic Surgeon.

My best wishes,

R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
wwwimagineplasticsurgery.com
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Breast Augmentation Incision

Thank you for posting your photos and questions. Judging by your photographs, you appear to be a good candidate for breast augmentation.
There are 3 commonly used incision sites for breast augmentation: inframammary fold, transaxillary and peri-ariolar. Each has pros and cons and generally speaking most plastic surgeons have their preference for incision site. However, ultimately, the choice is going to be up to you, the patient, to decide what is going to be best for you now and in the future.

I recommend consulting with at least or 1 more board certified plastic surgeons to discuss the pros and cons or each incision so you can make a well-informed decision.

Best of luck to you!

Mennen T. Gallas, MD
Katy Plastic Surgeon
5.0 out of 5 stars 18 reviews

"Best" access Incision/Scar for Breast Augmentation

Your question is very intelligent and it is obvious you did your homework. 

The fact that there are so many incisions to do the operations clearly indicates that there is no one best incision. Do surgeons have strong preferences about it? Of course they do but it does not make it a fact. 

In my opinion a good surgeon should be able to use all major 3 access incisions and let you, the patient decide how to do it. 

Thd he only truly reuseable scar is a peri areolar scar since in the future the breasts ( especially with implants over 350 cc implants ) will sag and need to be lifted. It is also the most hidden after an armpit scar. However the breast fold incision is much faster and does not involve going through as much breast tissue which may impact breast feeding in a small fraction of women. 

The he choice is yours? One scar( peri areolar) or two scars (breast fold) eventually with a lower rate of sensory and breast feeding  issues. 

Good Luck
Peter Aldea MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 102 reviews

Inframammary incision

The inframammary incision is best, as explained by the multiple other answers.

Given your concern for revision, as well as long-term issues for replacement, the inframammary incision is the most flexible and allows for the best visualization of the pocket, the best opportunity to get it right the FIRST time.

The PA incision might have a slightly less noticeable scar, if it heals correctly, but going thru the nipple/areola does carry a slightly higher risk if implant contamination and/or risk of infection, along with a slightly higher risk of loss of nipple sensation.

As for your 'chosen' size, I believe it is better to be evaluated by a BCPS, get measured, try on sizes, and then determine your desired, as well as optimal, implant size. You may have already done that. 

Best.

Kirk Moore, MD
Salt Lake City Plastic Surgeon
4.2 out of 5 stars 39 reviews

For a first time breast augmentation, what incision site is recommended for someone who has never had kids?

Hello! Thank you for the question! The typical incision used for breast augmentation are: inframammary (in the fold beneath your breast), periareolar (at the border of the areola), axillary (within the armpit crease), and TUBA (through the umbilicus). Incision placement will do a lot with your preference, surgeon comfort level with that approach, and the type of implant - silicone implants will be difficult to place within certain access incisions. Breast augmentation scars are well concealed and are very discrete. They should not be visible within clothing, and likely hidden without clothing. If your concern is the visibility without garments, you should consider remote access incisions such as in the armpit. However, these other incisions heal very well on the breast and often times inconspicuous.  My preferred approach is inframammary as it is well-hidden but allows the best visualization and ability to adequately shape the breast pocket

It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process.

If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.

Consult with a plastic surgeon your goals, concerns, and expectations. Certainly incisions should be considered, but should not limit your overall result by hindering visualization and access to your surgeon, and what produces the best results in his/her hands.

Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 24 reviews

Inframammary crease incision is best

Hello and thank you for your question. Getting a breast augmentation is an important decision. The procedure itself is half of the process, but the more important half is your recovery and long-term results. Lowering your risk for potential problems is key. In a straight-forward breast augmentation like yours, I prefer to use the inframammary crease incision because:
1) it is more well-hidden as you have nice lower pole cleavage and have a natural shadow/crease there that will hide your scar; the nipple-areola complex sits on the center of the breast and the scar can be quite noticeable in someone with your skin tone.

2) it gives a straight-shot access to develop a submuscular pocket and really control the boundaries of your breast pocket made to place the implant: it does not violate your inferior breast border (like an umbilical approach) or your lateral border (as in cases where people use the armpit and then end up with implants in the armpit). " Pocket control" is key for long-term results.

3) the inframammary crease is the cleanest of all sites compared to the nipple (where many glands and ducts exist), the armpit (where there are many sweat glands and hair), the umbilicus which harbors bacteria. Studies have shown that this decreased bacterial burden also decreases long-term potential for capsular contracture; furthermore, the crease is the least sensitive of all the areas and as patients heal, their scars may get sensitive and the crease decreases scar hypersensitivity issues. Speaking of sensitivity, cutting further away from the nipple-areola complex should theoretically further protect preserving nipple sensation.

I think you will have an excellent result with breast augmentation if you go to a board certified plastic surgeon with expertise in aesthetic breast surgery. Make sure to check reviews on yelp/realself/google+/Facebook/etc, before and after photos, following on instagram for the surgeons you are considering to gain a better understanding of the results they deliver for their patients and then go with someone who fits your needs best. I recommend going to several consultations so that you make a well-informed decision.

Take care,

Dr. Sean Kelishadi

Sean Kelishadi, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 22 reviews

Best incision

As you have learned, recommendations will vary from one practice to another. For example, in my practice, I prefer the infra areolar incision for most patients undergoing breast augmentation surgery and find the advantages of this approach outweigh the (mostly theoretical) disadvantages. Best wishes with your decision-making.  

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.