Breast Augmentation Incisions

Breast augmentation is a cosmetic surgery that enlarges your breasts, helping you feel more confident in your appearance. During the procedure, your surgeon will place a saline or silicone implant under the breast tissue. Although the surgery is mostly the same for everyone, you do have some choice about where your surgeon will make the incision to place the implant.

The most common incision sites are the armpit, underneath the breast, and around the areola. The best incision depends on the size of the implants, the shape of your breasts, and your cosmetic goals or expectations. You and your surgeon should discuss your options during your consultation and decide which type of incision is best for you.

Armpit (Transaxillary)

A transaxillary incision is made in the crease of your armpit. The surgeon usually uses a surgical camera to place the implant, which makes the placement very precise. The main advantage to a transaxillary incision is the location of the scar. Other incisions will leave scars on the breasts, but the transaxillary scar will be hidden in the crease of your armpit. This type of incision usually leaves the least visible scar.

However, if the scar heals poorly, it may be visible in sleeveless shirts. The scar isn’t visible for most patients, but there is a chance that it won’t blend into your skin or be completely concealed in your armpit. This is more common with silicone implants, which require a larger incision of 2 to 2.5 inches.

Transaxillary incisions also aren’t effective for treating sagging breasts, so they’re not a good option for everyone. Unlike the other types of incisions, transaxillary incisions can’t be reused for additional surgeries, so if you need another breast augmentation or similar procedure, you’ll have multiple scars.

Some people experience numbness around the incision site after it heals. This is very rare, though, and it almost always goes away within a few weeks or months after the surgery.

Underneath the Breast (Inframammary)

An inframammary incision is made in the fold directly underneath the breast. This is the most common type of incision and is usually recommended by surgeons, especially for silicone implants. It provides easy visibility for the surgeon during the procedure, so they can accurately place the implant. The incision site can be reused for additional surgeries, so you don’t have to worry about having multiple scars. Inframammary incisions are also usually the best option for treating sagging breasts.

The main disadvantage of an inframammary incision is the visible scar on your breast. For most patients, the scar is completely hidden by the breast. It may be noticeable when lying down, though. If your breasts are small or have a shallow fold, the scar may also be slightly visible when you stand up.

Around the Areola (Areolar or Peri-Areolar)

An areolar incision is made around the entire areola, and a peri-areolar incision is a semi-circle on the lower half of the areola. The advantages of these incisions are similar to the advantages of an inframammary incision. They provide easy visibility for your surgeon to place the implant, and the incisions can be reused for extra surgeries. Surgeons can also treat sagging breasts with areolar incisions.

For almost all patients who choose this incision, the scar is hardly noticeable or even completely invisible. It can blend in with the areolar tissue, so it won’t be as obvious as the other incisions.

Not everyone is a candidate for an areolar or peri-areolar incision. If your areola is too small for the incision, your doctor will probably recommend you choose a different option. The surgery can also affect the milk ducts on the breasts, which can complicate breastfeeding. If you plan on breastfeeding in the future, you may want to consider a different type of incision.

With areolar incisions, the implant will be exposed to breast tissue and bacteria during the surgery. This increases the risk of capsular contracture, which occurs when scar tissue builds up around the implant and makes your breast harden. This can be painful and usually requires another surgery to fix.

Which Incision Is Best?

All of these incisions serve the same purpose, but the best option for you will depend on your cosmetic goals and your anatomy. If you don’t want any scars on your breasts, a transaxillary incision might be best. If you want the surgery to lift up sagging breasts, an inframammary or areolar incision may be a better option. Your doctor will give you their best recommendation for the incision that will accomplish the most while leaving the least visible scar.

Dr. Steinbrech is a plastic surgeon specializing in breast augmentation in New York and Los Angeles. He trained at the NYU Institute of Plastic and Reconstructive Surgery and is certified by the American Board of Plastic Surgeons. He is also a successful researcher and has been involved in over 50 peer-reviewed publications. The Consumers’ Research Council of America has recognized Dr. Steinbrech as one of America’s Top Plastic Surgeons. You can visit his website to learn more about his practice: https://www.drsteinbrech.com/