When considering breast augmentation, one of the crucial decisions is the choice of incision for inserting the implants. The incision site affects the aesthetic outcome, the recovery period, and potential scarring. Here we explore the main incision options, with their benefits and considerations, so you can make an informed decision.
Inframammary Incision
The inframammary incision is the most common and popular option. It is made in the natural crease under the breast, providing direct access to the implant pocket. The incision can be small for saline implants and up to about 2 inches (5 cm) for the largest silicone implants. Benefits include:
- Optimal visibility for the surgeon during implant placement
- Ability to place a wide range of implant sizes and types
- Minimal interference with breast tissue, reducing the risk of complications
- A well-concealed incision that tends to heal nicely over time
Consideration: the scar is on the breast and can be visible without clothing in an arms-up position.
Periareolar Incision
The periareolar incision is made along the lower edge of the areola, where the darker pigmented skin meets the surrounding breast tissue. The idea is that this natural color-transition zone can hide a well-placed scar. Advantages include:
- Camouflage within the natural color transition of the areola
- Direct access with precise control over implant placement
- Potential for simultaneous areola adjustment or nipple repositioning, if desired
- A scar that often blends well due to the natural color variation
Considerations: a higher rate of capsular contracture, a limit on incision size based on areola diameter, possible change in nipple sensation, and potential effect on breastfeeding.
Transaxillary Incision
For those seeking an incision away from the breast itself, the transaxillary incision is made within the armpit, through which the surgeon creates a tunnel to place the implant. Benefits include:
- No scarring on or near the breast itself
- A hidden incision within the armpit, easily concealed by clothing
- Minimal interference with breast tissue
- Suitable for saline or smaller silicone implants
Considerations: higher rates of malposition and capsular contracture, visibility of the scar in an arm-raised position with sleeveless outfits, and size limitations on the desired implant.
Using a Mastopexy Incision (during a breast lift)
For patients undergoing a simultaneous breast lift with an implant (augmentation mastopexy), the implant is typically placed through an incision that is already part of the lift, so no additional scarring is needed.
For an inverted-T lift, I always place the implant through an inframammary-fold approach and close that incision from deep to superficial before starting the lift — keeping the implant separate from the more superficial maneuvers that could contact skin and raise the risk of capsular contracture. For vertical (lollipop) lifts, I use the vertical incision to place the implant and again close the pocket before performing the lift. For a donut lift, I may place the implant through a fold incision and perform the donut lift separately, to limit disruption to the breast.
Transumbilical Incision (TUBA)
The transumbilical incision, or belly-button approach, is far less common. Considerations:
- Incision made within the belly button — no scarring on or near the breasts
- No interference with breast tissue
- Only suitable for saline implants, with more limited implant placement
- Requires specialized expertise; largely historical, as most surgeons no longer offer it due to increased rates of malposition, infection, and capsular contracture
The Bottom Line
Choosing the right incision is a personal decision that should account for your desired outcome, your preferences, and your surgeon’s advice. Each option has its own benefits and trade-offs, and what works for one person may not be ideal for another. Because I prioritize safety, I typically recommend the safest, evidence-supported option — the inframammary fold approach. The best way to decide is an open conversation at your consultation.