Which is the Best Incision site for me?

I have uneven breast and I want as minimal scaring as possible. I am biracial with no history of keloids. Which is the best incision site to create the best "pockets" under the breast, periareolar or inframammary? My PS gave me those two choices (I didn't want axillary even if it was possible). If I decided to go with a periareolar incision, will the shape, size, and color of my nipples change? (Right now they are light brown)

Doctor Answers 6

Which is the Best Incision site for me?

Thank you for the question. Both the infra mammary and infra areolar incisions are good approaches.  I personally, having used each incisional approach several thousand times, prefer the infra areolar approach for most patients, undergoing first time and revisionary breast augmentation surgery.   I think the advantages of the infraareolar incision far outweigh any theoretical disadvantages. These advantages include proximity to the planned dual plane submuscular pocket dissection,  relatively hidden/forgiving location of scarring,  coverage by clothing/swimming suit etc.
In my practice, I use the funnel for all breast augmentation procedures involving silicone gel breast implants of all sizes. I believe that the use of the funnel allows for the use of a smaller incision and for easier breast implant insertion ( allowing for a “no touch technique” and no contact of the breast implant with the patient's skin). Hopefully, in the longer term, it will be shown to  definitively decrease the incidence of encapsulation as well.
Best wishes.

Which is the best incision site for me?

If your surgeon gave you the choice of periareolar or inframammary incision, then you are most likely a good candidate for either, especially with no history of keloids.  Some recent studies have shown that the inframammary fold is a "better" incision site as there seems to be a lower rate of developing a capsular contracture (scar tissue).  This is my preferred incision and have never had a complaint from my patients about it.  You will not see it when looking directly into a mirror and you can use this same incision for future procedures.  Best of luck! ac

Angela Champion, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 5 reviews

Breast lift

Thank you for the question.

To best help you, a physical examination or picture evaluation is required for an accurate review. Feel free to post some pictures in order to determine which procedures and techniques would be the best ones for your case.

Dr. Campos

Jaime Campos Leon, MD
Mexico Plastic Surgeon
4.4 out of 5 stars 241 reviews

Incision Choice in Breast Augmentation

Either a periareolar or inframammary incision give excellent results.  There is no change in the color or shape of the areola when the periareolar incision is used.  Sensation is also the same in both incisions.  Although I have, in the past, preferred the periareolar incision, there is some new data that suggests that capsular contracture rates and subclinical infections are reduced by using the inframammary incision.  Frequently this is the only incision that is reasonable with the newer cohesive gel implants, since a larger incision is needed in order to get the implant into the pocket without undue force.  Other than these considerations, choice is purely subjective.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 5 reviews

Incision location

I think inframammary and periareolar incisions are both good choices for scar location.  You mentioned you're biracial.  For my Asian patients, I recommend periareolar incisions because they usually hide much better than the inframammary scars.  Asians tend to develop dark scars which hide nicely with the color of the areola.

Eugene Kim, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 50 reviews

Best incision location for breast implants

Thank you for your question.  Incision location for breast augmentation is often baed on surgeon or patient preference.  I almost always place my incision in the inframammary location because it will not be visible when looking straight at the breast.   

A periareolar incision is very reasonable provided the areola is wide enough.  A small areola will not allow an incision long enough to allow adequate exposure for implant placement.  In some patients with tuberous  breasts or an absent inframammary crease, a periareolar incision is a good option.  Remember that the scar will always be visible when looking at the breast with periareolar placement.  With time, the scar will fade but will always be there.  

Either scar location will give you adequate access to create an appropriate pocket.  With a periareolar incision the shape, size, and color of the  nipple should not change.  If you still are unsure, visit again with your surgeon to help make the best decision for you.  Good luck!

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.