When placing breast implants, there are four main types of incisions (or “approaches”) your surgeon can use. The choice depends on your anatomy, implant size, aesthetic goals, and the surgeon’s technique.
1. Inframammary Incision (Under the Breast)
This is the most commonly used incision in the United States, especially for patients with a clearly defined natural breast fold (the crease under the breast).
Advantages:
- Allows the procedure to be performed on an outpatient basis — no drains, minimal pain, and discharge the same day.
- Minimizes the risk of capsular contracture (scar tissue around the implant), as it avoids contact with the mammary gland and associated bacteria (biofilm).
- Easily accommodates larger implants (over 400 cc).
- Rarely affects nipple sensitivity.
- With the use of an endoscopic camera and a Keller Funnel, the scar can be kept under 3 cm and is typically well hidden in the fold.
2. Axillary Incision (Through the Armpit)
This technique places the scar in a natural skin fold in the armpit, leaving no scars on the breast itself.
Advantages:
- Endoscopic tools allow for precise implant placement and bleeding control, reducing the risk of implant mispositioning or hematomas.
- Ideal for patients with very small areolas that cannot accommodate implant insertion.
Considerations:
- This approach is more complex, requiring longer surgery time and higher costs.
- Post-operative physiotherapy is often needed to avoid fibrous bands (known as “bridles”) forming in the armpit area.
3. Trans-Areolar Incision (Through the Nipple Area)
This incision is made directly through the nipple/areola.
Limitations:
- Only suitable for inflatable saline implants or small silicone implants (under 250 cc).
- Higher risk of nipple sensitivity issues post-surgery.
- The scar is usually discreet, but this method is rarely used today due to its limitations.
4. Inferior Peri-Areolar Incision (Bottom of the Areola)
Used in approximately 20% of cases, particularly for patients with breast ptosis (sagging), this method provides direct access and excellent visibility for precise implant placement.
Benefits:
- Allows for implant volumes up to 450 cc, depending on the areola size.
- Ideal for combining augmentation with a breast lift when needed.
Drawbacks:
- Slightly increased risk of capsular contracture due to potential exposure to bacteria in the milk ducts during implant insertion.
→ To reduce this risk, we often use polyurethane foam-covered implants with this technique. - Greater chance of sensitivity changes in the nipple and areola.
In rare cases, retractive scarring can distort the shape of the areola.