Incision Options in Breast Augmentation: Inframammary, Areolar and Axillary

Incision Sites in Breast Augmentation: Around the Areola, Under the Breast and in the Armpit

In breast augmentation, the incision through which the implant will be placed is an important choice that affects both scar visibility and the surgeon's control. Let's examine the three basic approaches and their advantages.

Inframammary Incision (Inframammarian)

It is the most frequently preferred method. The incision placed in the submammary fold provides the surgeon with the best view and control. The scar is hidden in the sub-breast fold and becomes obscured over time. Suitable for most types of implants.

Incision Around the Areola (Periareolar)

The incision is placed on the lower edge of the areola; The color transition helps camouflage the scar. At the same time, if there is slight sagging, it provides an advantage when it can be combined with lifting.

Armpit Incision (Transaxillary)

The incision is placed under the armpit; Thus, there will be no scar on the breast. It may be preferred for patients who do not want scars in their natural breast tissue. However, it may not be suitable for every patient and every implant.

• Under breast: best control, hidden scar
• Areola surroundings: camouflage in color transition
• Armpit: no scar on breast

What Determines the Choice of Incision in Your Case?

• Size and type of implant: Because silicone implants are inserted pre-filled, a larger implant needs a longer incision. For this reason, with large implants, the areola or armpit may not always provide sufficient access.
• Diameter of the areola: If the areola is small, an incision around it may not be long enough for the implant to be inserted safely.
• The fold under the breast: If the fold is not well defined or will be lowered during surgery, the incision is marked in advance so that the scar falls in the new fold.
• Breast shape: In breasts with a narrow base and an underdeveloped lower part, an incision around the areola may also allow the breast tissue to be reshaped.
• Skin characteristics: A history of raised scars or keloids, darker skin and a tendency for scars to change color affect the answer to where a scar will attract less attention.
• Implant placement plane: Whether the implant is placed under or over the muscle is planned together with the incision; for example, the armpit approach is mostly used with placement under the muscle.
• Previous operations: If there is already a scar on the breast, it is often reused whenever possible so that no new scar is added.
• Breastfeeding plans: Incisions around the areola are closer to the milk ducts; this is explained in detail in does breast augmentation affect breastfeeding?

How Do the Incisions Differ in Healing and in the Long Term?

• Under the breast: When standing, the scar usually stays hidden in the fold; it may be visible when lying on your back or raising your arms. In the first weeks, the wire of an underwire bra may press on the scar and irritate it. If the implant needs to be replaced in the future, the same scar can usually be used.
• Around the areola: The scar is hidden at the color border; in some people, however, it may remain as a thin line lighter than the surrounding skin. The possibility of temporary or permanent changes in nipple sensation is discussed more often with this incision. With this incision, the implant pocket is often reached by passing through the breast tissue; for this reason, it is assessed differently from the other incisions with regard to the milk ducts and breast tissue.
• Armpit: It leaves no scar on the breast, but tightness may be felt with arm movements in the first weeks, and the scar may be visible in sleeveless clothing or when the arms are raised. If the implant needs to be replaced or removed in the future, a new incision on the breast is often required. With this approach, the pocket for the implant is sometimes prepared with the help of a thin camera (endoscope).

Implant replacement and removal are discussed in breast implant removal and replacement.

Questions You Can Ask Yourself When Deciding

• Which clothes do you wear most in daily life: bikinis and low necklines, or sleeveless tops?
• Is it more important to you that the scar is hidden, or that there is no scar on the breast at all?
• Are you planning a pregnancy and breastfeeding in the near future?
• How important is it to you that the same incision can be used if the implant ever needs to be replaced?
• How would possible restrictions on arm movements and bra use in the first weeks affect your work and daily routine?

"The decision on the incision location is made according to your tissue structure, implant type and scar expectations. The right technique aims for safe placement while keeping the scar as inconspicuous as possible."

—Dr. Mustafa Keles

No matter which technique is chosen, with meticulous surgery and correct scar care, the scars will fade over time. Sharing your expectations during the consultation will help determine the most appropriate incision site.

Frequently Asked Questions