Breast Augmentation - Site of Incision

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Deciding where to insert the implant is extremely important in breast augmentaion process. Incisions may be placed under the breast, around the nipple, under the arm, or through the belly button. Find out more about site of incision and discuss with your surgeon which is the best option for you.

Under the Breast

An incision under the breast, also called inframammary incision, is hidden along the natural skin crease, in the shadow of the breast. It often heals inconspicuously and affords the surgeon excellent visibility for surgery. But if it heals poorly, it will be visible when you are wearing no clothing. If your surgeon needs to lower your breast crease for optimal positioning of the implant, your scar might end up on the undersurface of the breast, rather than in the crease. Women who have asymmetric breast creases before surgery should expect asymmetrical positions of their scars after surgery. One of the chief advantages of this incision location is that it allows your surgeon to lower the implants (if needed) while they are in place. This may help your surgeon achieve better breast implant position symmetry.

Around the Nipple

An incision around the nipple is designed to camouflage the scar by placing it at the junction of the nipple skin, called the areola, and the surrounding skin. Typically the incision goes halfway around the areola. Because of the natural color transition in this area, the scar is not easily seen. Many surgeons use this incision, also called the periareolar incision, with good results. However, because the nipple is the focal point of the breast, any imperfection, no matter how small, will be obvious. Also, this incision imposes a slightly higher risk of nipple numbness than the other incisions. Finally, because areola size limits incision size, women with small areolas or large silicone implants may not be candidates for this incision, as implant placement might not be technically possible.

Under the Arm

Using an endoscope, which is a pencil-sized rod with a fiber-optic camera on its tip, surgeons have achieved good cosmetic results with an incision under the arm, also called the transaxillary incision. Because silicone implants arrive prefilled from the manufacturer, large silicone implants may be difficult to place through this incision, thereby rendering this incision ill-advised in women seeking large silicone implants.

The scar is well hidden. But if the scar remains noticeable after healing, it will be visible in evening gowns, tank tops, and bathing suits. It will be especially visible in women with olive or brown skin. It can also be a telltale sign, particularly for women who participate in aerobics.

Through the Belly Button

Also called transumbilical breast augmentation (TUBA), placement of implants can be performed through a small incision inside the belly button. It is only an option for saline implants, as silicone implants are too large to fit through the incision. Also, it is used mostly for subglandular placement, as subpectoral placement through the belly button is fraught with implant malposition and hematomas. Because subglandular saline implants present several aesthetic disadvantages (e.g., rippling, wrinkling), many women find this option has more disadvantages than advantages.

Length of Scar

Because saline implants are filled after they are placed, your surgeon can use a small (3—5 cm) incision. Because silicone implants are prefilled by the manufacturer, the incision must be long enough to accommodate the implant. Small implants (less than 350 mL) can often be placed through a 3-5 cm incision. Medium implants (350-500 mL) can often be placed through a 4—6 cm incision. Large implants (greater than 500 mL) often require a 5—8 cm incision.

Scar Visibility

Usually, scars from breast augmentation fade. Occa-sionally, they become wide or unsightly. The final visibility of your scar depends more on your healing process than on your plastic surgeon's technique. It may take one to two years for your scar to mature.