Breast Augmentation: Cost, Reviews, Photos

The most popular among surgeons is the breast crease, followed by the areola. Distant third is the armpit and really distant fourth is the belly button. 

The most important determinant in getting a fantastic breast augmentation is having perfect pockets made for the implants, not the scar.

Breast implants can be put in through four different approaches. You can have the incision in the underarm, under the breast, at the edge of the areolae and in the belly button.

There are advantages and disadvantages to al of them. The underarm approach is good for avoiding scars on the breasts.

You should not be concerned about extra swelling or lymph node damage as this is very unlikely. However, in a warm weather climate (like Miami where I practice) the underarms may not be so discrete when wearing a tank top, strappy or sleeveless top.

If you do not heal perfectly well you might have noticeable scars in an area that shows, even wearing clothing. There is also a somewhat higher risk for the implants to sit too high or to fat to the side with that approach.

The belly button approach is my least favorite for many reasons. It leaves a visible scar on the belly button, the operation is done blind through a tunnel, and the warranty on the implants is broken by placing them through this approach.

Under the breasts is a good place to have the incision though it does leave a visible scar. The natural hang of the breasts usually hides the scar well.

I generally prefer the incision to be at the edge of the areolae. I find it to be the most discrete. The scar usually blends in so well it is difficult to find even when looking for it.

There are lots of things to consider when choosing the incision for your breast augmentation. You should seek the advice of a surgeon that is certified by the American Board of Plastic Surgery.

He/She can give you the information you need to make the best choice for yourself.  (Adam Rubinstein, MD, Miami Plastic Surgeon)

Breast augmentation and incision

Implants can be placed through several different incisions. I prefer periareola or crease. I think they afford the most direct access. (Steven Wallach, MD, )

The best place to make perfect pockets is from the crease. (Richard P. Rand, MD, FACS, Seattle Plastic Surgeon)

Breast Augmentation Under the Arm

In terms of popularity and use by plastic surgeons, the crease or breast fold (infra or submammary) is the most common followed by the nipple (periareolar) followed by the arm pit (transaxillary incision) followed by the belly button (transumbilical).

If performed correctly there is little risk to the lymph nodes or increased swelling after breast augmentation. (Otto Joseph Placik, MD, Chicago Plastic Surgeon)

Which incision is best for breast augmentation surgery

There are several incisions which can be used for breast implants and each has its advantages and disadvantages.

Although a transaxilarry incision is championed by many due to the scar being well hidden, it does have its limitations.

It is difficult placing a larger silicone breast implant through this incison and a separate incision is often necessary if an implant or capsule needs to be removed or a revision performed.

If a lift is needed, this cannot be performed through a transaxillary incision and would require a second separate incision.

Whether a periareolar or crease (breast fold) incision is used, both of these are well concealed and allow good exposure and access to the breast pocket.

Remember the only way these incisions are visible is when a woman is naked from the waist up. This is not the case with a transaxillary incision. Ultimately, your wife and her plastic surgeon should make the decision on which incision is best for her. (David A. Robinson, MD, Munster Plastic Surgeon)

Choices for incision for breast implants

The common choices are

1. crease
2. peri-areolar
3. trans-axillary
4. trans-umbilical

I will use the first three, but not number 4, for too many reasons to list here. There are pros and cons to each and the patient should have the final choice in my opinion. In a nutshell, #1 gives the surgeon the most control and is the most common approach. Generally heals very well and scar quality will rival the periareolar scar in time. #2 scar looks better sooner, but potential risks are: increased risk of nipple sensation changes and the surgeon must cut through breast tissue. We do not yet know if that leads to an increased risk of capsular contracture. Also, if the scar does not heal well, it will be more noticeable. #3 scar is off the breast, but if it doesn’t heal well, then will be noticeable in a bathing suit. Also, implants seem to have more tendency for lateral migration with this approach. Discuss all with your surgeon and then decide what is best for you! (Dean Fardo, MD, Atlanta Plastic Surgeon)

Incision location for breast implants

I think the best incision for breast augmentation that will give you the least complications is the crease incision (under the breast) – period. You don’t see it and it heals without any problems. The periareolar incision is visible in some patients, in others it can leave a white noticable line that is distinct from the areola, it has a higher incidence of nipple sensitivity changes after surgery, and it absolutely has a higher incidence of capsular contraction than the crease approach. The transaxillary incision has a much greater chance of implant malposition and unevenness. The transumbilical incision is another bad choice that I would not consider. (James F. Boynton, MD, FACS, Houston Plastic Surgeon)

The best incisions for breast implants

There are many options for breast breast implants. What type implant is she interested in? If she has chosen a silicone implan,t I agree with others that she may be better off with an inframammary crease incision. I personally prefer this incision and the majority of augmentations that I perform are through this incision. The crease incision affords great visibility and few complications. (Suresh Koneru, MD, San Antonio Plastic Surgeon)

Ultimately, the choice of best incision site is up to your wife, with the guidance of her surgeon.

Each patient’s anatomy is different, and there is no perfect incision in each and every patient.

In terms of popularity, national surveys have shown that the under the breast incision is by far the most popular.

It also allows access in the future for any possible implant change, or removal.

The second most common (and it’s a distant 2nd) is the peri-areolar incision.

The trans-axillary (armpit) incision is the third most popular, and is not appropriate in some cases.

I perform all 3 incisions in my practice, but discuss the pluses and minuses with each patient, so that they can make an informed choice.

FYI the belly button incision which some patients ask about is rarely performed, and has a high rate of implant malposition. It also can not be used with a silicone implant. (Darrick E. Antell, MD, Manhattan Plastic Surgeon)

Best incision site for breast augmentation

There are 3 typically used incisions for breast augmentation, the transaxillary, periariolar and crease . Here is the truth about each. First, the transaxillary incision moves the incision from the breast to the armpit. It is technically more difficult to create the pocket and leaves a visible scar if the patient raises her arms wearing a sleeveless shirt or dress.

The advantages are. Okay, I don’t see any. Especially in darker skinned women where the scar will end up darker than the surrounding skin. The periariolar incision is the most camouflaged. I use this if I’m doing a breast lift. However, it’s a one time incision.

Studies have shown that if the implants need to be replaced and the periareolar incision is used a different plane is often used. This compromises the blood supply to the skin.

In addition the scarring of the breast may be interpreted poorly on a mammogram creating concern and the need for further study. I place the incision 1cm below the inframammary fold (breast crease).

Using this incision the duel plane can be directly dissected without injury to the breast tissue and after placement of the implant the scar ends up exactly in the fold. No one ever sees the scar. (Christopher L. Hess, MD, Fairfax Plastic Surgeon)

Incision site choice for breast augmentation

There are 4 locations where an incision can be placed for breast implant surgery – under the breast in the fold, around the areola, in the armpit and the belly button. By far the most commonly used site is the one under the breast in the fold – the crease fold incision – as it is formally known as.

The reason for that is it is well hidden, has the most direct route for implant placement and pocket dissection. Also, if you do have future surgery, such as for implant rupture or capsular contracture it can easily be used again. The peri-areolar site is the second most common followed by armpit and belly button. With silicone gel implants now being the most common implant used again, the crease fold incision will continue to be the most commonly used site. Remember – most women expose their armpits and belly buttons on a regular basis but their breasts are covered with a bra or bathing suit almost all the time. The only two people that will see a breast fold scar are you and your wife. (Bahram Ghaderi, MD, Chicago Plastic Surgeon)

It is confusing, because there is no one best answer.

Typically, the crease incision is used because it is a very straight course to submuscular implant placement.

The less disruption of breast tissue, the less scar tissue that can be present, and affect mammography.

Also, if the scar does not heal well, it is less visible. (David A. Lickstein, MD, Scottsdale Plastic Surgeon)

Which Incision Is Best for Breast Augmentation?

Obviously, the best incision is one that is optimal for you.

There are 3 incision options;

1. transaxillary
2. around the areola
3. and the crease.

My preferred incision is the inframammary fold if you have indeed any breast tissue or a well-defined inframammary fold. If you have any type of asymmetry this gives you the most optimal access incision with the least amount of complications or revisions and the least potential for nipple sensory loss. There is a higher chance for nipple sensory loss when using areola and transaxillary incisions. If one is a patient of color, has no breast tissue, or has no inframammary fold then the transaxillary approach is preferred. (Rod J. Rohrich, MD, Dallas Plastic Surgeon)

Incisions for Breast Augmentation – Where to Place the Scar?

All three approaches are good options and can provide excellent results. I perform all three, and each approach has pros and cons which you need to consider. The transaxillary approach creates a scar away from the breast, which may be visible when you raise your arms in a bathing suit or sleeveless shirt. High riding implants can result with this approach, but are usually avoided by an experienced surgeon.

The periareolar incision is quite popular and creates a scar which is well hidden by the color change between the nipple and skin. When performing a periareolar augmentation, the surgeon must incise through the breast tissue which can theoretically be contaminated by bacteria from the breast ducts. In theory this may result in a higher risk of infections and/or capsular contracture. The crease approach provides the surgeon with excellent control. Ideally, the scar is placed in the inferior breast crease, but after augmentation the scar may have a tendency to migrate upwards (above the crease). Knowing the pros and cons, I let my patients decide which approach is best for them. (Frank Agullo, MD, El Paso Plastic Surgeon)

Incision for breast Augmentation

The incision that is used will depend on the type and size of implant and other factors that are patient driven. The least visible incision is the areolar incision. The problem is that if the areola is small, silicone gel implants may not fit through that incision. Also there is a slight increased risk for loss of nipple sensation with this approach. Silicone gel is not recommended through the axillary incision. The most common is the crease incision and if done properly the scar is well hidden (but stll can be seen if the breast is lifted up) So. the answer is up to you. Trust your board certified plastic surgeon and your own judgement. (John P. Stratis, MD, Harrisburg Plastic Surgeon)