Many women are not aware of the multiple potential incision sites for breast implant implants. However, there are different benefits and risks from each site, so it is important to learn about all the options.  Cosmetic surgeons can use one of three incision sites:

  • Underneath the breast, along the crease in the breast (inframammary)
  • Directly above or below the nipple (periareolar)
  • Along the rib cage within the armpit (axillary)

Some surgeons also use an incision in the belly button to perform the procedure called transumbilical augmentation (TUBA), but the FDA has not approved this procedure.

Inframammary Incisions

Inframammary incisions, made underneath the breast along the rib cage, are the most popular type of incision, but the scar that accompanies them is also the most prominent, especially if you are thin or have smaller breasts. Both saline and silicone implants can be inserted into the breasts using inframammary incisions. This incision location allows the surgeon to have the most control over where the implant is placed.    

Periareolar Incisions

Periareolar incisions are made on the edge of the areola, the dark part of the nipple. The scar in this procedure blends in with the dark areola tissue, making it less noticeable than other potential scars. Surgeons can use this incision for both saline and silicone implants. However, because silicone implants are already filled before they are placed in the breast, this procedure tends to be more difficult with saline implants because of the size of the incision.

One drawback to periareolar incisions is the patient’s increased risk of infection in the breast. During this procedure, the surgeon must cut through the milk ducts in the breast, which contain bacteria natural to the production of breast milk. These bacteria can cause an infection if they spread to other parts of the breast.

Axillary Incisions

The axillary or transaxillary incision is cut underneath the armpit, making a less-noticable scar than an inframammary incision. To successfully position implants, surgeons must use an endoscopic camera to monitor the operation. Empty saline implants are most commonly used for this type of surgery because they can be filled after they have been placed in the breast. Axillary incisions are most commonly chosen for a woman’s first breast augmentation procedure. In subsequent procedures, the inframammary incision is most often used.

Disadvantages of the axillary incision include a greater possibility of the implant being misplaced or malpositioned than during a periareolar or inframammary incision. If the implant is misplaced, an inframammary incision may be used to adjust the positioning of the implant. Another possible complication is the development of Mondor disease, a benign condition that causes fibrous bands to develop on the breasts.