Choosing Breast Augmentation Incisions

By Dr. Scott W. Mosser

There are four incision options with breast augmentation, each with its particular benefits and drawbacks. Incision preference is also related to the type of implant you’ve chosen as some incisions cannot be used for certain implants. The four types of incisions are: periareolar, inframammary, transaxillary, and transumbilical.

Periareolar Incision

Periareolar incisions are among the most popular incisions currently used by surgeons to insert implants during breast augmentation. The periareolar incision is made around the edge of the nipple where it meets the surrounding breast tissue.

Some benefits:

  • The scar from the incision is very difficult to see, as it blends well with the natural change in skin color.
  • This incision allows the surgeon to place implants either under the muscle or under the glandular tissue of the breast.
  • It gives the surgeon the greatest degree of precision due to the close proximity of the incision to the placement site.
  • If there are any subsequent complications after the initial breast augmentation surgery, an additional incision will not typically be required as the surgeon is usually able to go in through the original periareolar incision, eliminating additional scarring.

Inframammary Incision

The inframammary incision, which is made in the fold under the breast, is also a very popular surgical option for breast augmentation.

Some benefits:

  • A major benefit of the inframammary option is that women would theoretically experience less difficulty breastfeeding after breast augmentation. The type of incision bypasses the milk ducts, posing less risk of damage to those areas.
  • The scar is relatively inconspicuous after surgery, and is often hidden within the lower breast fold when the chest is in the upright position. However, this scar is generally not so inconspicuous as the scar from a nipple area incision.
  • Like the periareolar option, the inframammary incision allows for placement of the implants either under the pectoralis major muscle or under the glandular breast tissue.
  • If there are any postoperative complications, the surgeon will typically be able to re-use the inframammary incision without needing to make any additional incisions.

Transaxillary Incision

The transaxillary incision is made under the arm, so a primary benefit is no scars in the breast area at all. It is possible to see the transaxillary scars when the arms are lifted, but the incisions are placed as inconspicuously as possible to mitigate their visibility. The surgeon makes the transaxillary incision and cuts a channel from the armpit to the breast area, either with or without the use of an endoscope (a small surgical camera that allows the surgeon to guide the implants into their final position).

One potential drawback of the transaxillary incision is the increased risk of less than perfect placement of the implants as there is more possibility for error since the incision site is further away from the implant’s final destination.

Another drawback to transaxillary incision is that if subsequent surgery is ever required, it is generally not possible to reuse the same incisions. For corrective surgery, the surgeon would typically have to use the periareolar or inframammary technique, adding additional scars.

Some studies have also shown that the transaxillary technique can cause a loss of nipple sensation after surgery.

The transaxillary incision technique is associated with less difficulty than the periareolar incision site when breast feeding.

Transumbilical incision

The least common incision preference is the transumbilical incision, where incisions in the belly-button area are used to place the implant. This incision is rarely used because of the relative difficulty with obtaining good placement of the implant beneath the muscle. Through the transumbilical approach.

The Final Decision: Let’s Decide Together

Because this decision ends up being so personal, and so variable depending on each woman’s priorities, I make it a point during a consultation to explore the pros and cons of each choice. Most patients choose the incision beneath the breast (also called the inframmary incision) because it is hidden within the breast fold and therefore is entirely hidden when the patient is in the upright position. However, an excellent result can be obtained with the other choices as well. This is a case where there is certainly no right or wrong decision, but the correct choice will reveal itself when we can take advantage of good doctor-patient communication in person.


Copyright © 2006 by Dr. Scott W. Mosser. This article may not be copied or reproduced in any form without the written permission of Dr. Scott Mosser. Internet links to the sub-page containing this article are permitted.