Breast Augmentation: Cost, Reviews, Photos

Underarm is great incision site for silicone implants

I have placed over 4,000 implants (about 80% were saline and 20% silicone) through the underarm approach using an endoscope. Because the underarm skin is thin, it will eventually leave a thin scar.

An experienced surgeon can hide your scar and keep your breasts scar-free. Be sure he or she uses a Keller Funnel to minimize the scar size. I highly recommend it! (Victor Ferrari, MD, FACS, Charlotte Plastic Surgeon)

Nipple vs Armpit incision types… where can you hide the scar better?

If your nipples are too small to accommodate the implants, then you have no choice but to go through the armpit. Of course, the breast fold is also an option. 350cc implants are not too big, and in our experience even small nipples can be used with a Keller funnel to get the implants in through a tiny incision. (Martin Jugenburg, MD, Toronto Plastic Surgeon)

Breast implant incision location types

In women with small nipples or those who are not willing to risk a change in their nipple sensitivity I generally recommend that they have their implants placed via an incision underneath the breast. This approach leaves a well placed implant and a minimal scar. (Christopher J. Davidson, MD, FACS, Boston Plastic Surgeon)

We offer four different incision types for saline and three for silicone. The three for silicone include armpit, inframammary fold, and the nipple.

If your nipples are small, then the nipple approach is not recommended. Through the armpit, you will have scars that may be visible when you raise your arm.

Also, you do have to purchase an additional device called the keller funnel to put the implant in through the armpit.

If you choose the crease or inframammary incision the incision is typically hidden in the crease. It hides well under your bra or bathing suit.  (William J. Hedden, MD, Birmingham Plastic Surgeon)

Implant incision.

When choosing a silicone implant most plastic surgeons would advise for a inframamary approach. The periareolar approach would not be recommended in your case for a 350 mL implant to to the small size of your areolas.

The underarm incision type is a possible approach however it appears that the capsular contracture rate, infection rate, implant opposition rate, and revision rate are higher with a trans axillary approach. I recommend that you see a board-certified plastic surgeon and possibly seek a second opinion. (Christopher Khorsandi, MD, Las Vegas Plastic Surgeon)

Saline implants may be placed through armpit incisions. Silicone Implants can be placed through nipple and inframammary incisions only. (Mel T. Ortega, MD, Miami Plastic Surgeon)

Which type of breast augmentation is best?

A small areola may preclude the periaroelar incision for the placement of a silicone implant. The underarm or infra-mammary incisions are both acceptable choices. The scar from the inframammary incision placed in the crease of the breast is usually very difficult to find. (George C. Peck, Jr, MD, West Orange Plastic Surgeon)

Short Incisions for Breast Implants

If your surgeon uses excellent technique, then he/she should be able to place even large implants through very small incisions. Because I use a Keller Funnel, I am able to place even large implants through an incision that is less than 1.25 inches. This will work for women with very small areolae. I disagree that the underarm (axilla) incision type is a good option.

The data shows that this approach has a significantly increased risk of complications and this approach has fallen out of favor with those surgeons who are up to date on the latest data. (Matthew Schulman, MD, New York Plastic Surgeon)

Silicone Implants and Incision Required

As others have mentioned there are four incisions that are used to place a breast implant. The periareolar and inframammary are the two most popular and the TUBA (trans-umbilical) Trans-axillary (arm pit) are the not some common ways.

There are many good reasons why most plastic surgeons don’t recommend the arm pit and the belly button incisions. The periareolar and inframammary are great incisions because they allow direct visualization of the pocket to be created and an easy way to control hemostasis. As far as your case, judging by your areola size and the implant size, 350 cc, in my hands it would not be an issue to place those thru a periareolar incision, especially with the use of the funnel.

I would think that other plastic surgeons would agree with this assessment. (Farbod Esmailian, MD, Orange County Plastic Surgeon)

Armpit incision is not optimal for implants

For a number of reasons I tend to steer clear of transaxillary, or underarm, incisions. Aside from the fact that the rates of malposition and capsule contracture are higher with these procedures than inframammary approaches, they leave a visible scar more times than we would like to admit. And if you are using silicone gel, that scar will be longer still because the implant cannot be inserted in a deflated state like saline implants can.

Lastly, if you ever need a revisional procedure, like lift or capsulectomy or replacement of ruptured implant, you will need an incision on your breast anyhow. I just don’t see the payoff with that approach. If your areola is too small to comfortably accommodate a silicone implant, then the inframammary approach would be advisable. (Joseph L. Grzeskiewicz, MD, San Diego Plastic Surgeon)

Type of Incision for Breast Augmentation

More people are going to see your underarm than your breast. By far in my opinion the incision under the breast is the best for breast augmentation and unless you are going topless, they won’t show in the summertime. After a year its hard for me to find them in most patients. Choosing an incision approach for silicone breast augmentation. (Mark A. Schusterman, MD, Houston Plastic Surgeon)

Choosing an incision approach for silicone breast augmentation.

More than 95% of my patients select a silicone implant for their breast augmentation. In general, I perform half of these via a periareolar approach and the other half via an inframammary fold incision. In general, I prefer not to place a silicone implant via the axillary (armpit) approach unless i am using a saline implant or a very low profile silicone implant. However, I prefer to use moderate-plus, high profile, or extra high profile implants for most of my patients and it is very difficult to use these through the axilary approach. Having said this, I am sure there are some surgeons who may do this via the underarm approach. From a quick glance at your photos, your areola do not appear too small for the periareolar approach, especiallly if a Keller funnel is utilized. Armpit incision is an excellent choice if your surgeon knows 9and has experience) how to do it (Sanjay Grover, MD, Orange County Plastic Surgeon)

Armpit incision is an excellent choice if your surgeon knows 9and has experience) how to do it

This is my procedure of choice for both saline and silicone implant for the last 15 years. After performing thousands of these operations i feel confident that this is THE BEST choice for most women. It is however technically challenging procedure and most surgeons are not comfortable performing it and therefore direct patients towards other options (Gregory Turowski, MD, PhD, FACS, Chicago Plastic Surgeon)

Breast augmentation incisions for silicone implants

The most common breast augmentation incisions are under the breast (inframammary), through the areola (periareolar), tunneled from the belly button (transumbilical breast augmentation), and through the armpit (axillary).

Of these, silicone implants cannot be placed through the belly button.

In all of these procedures, there is a permanent scar. The least conspicuous is the belly button, but also limits your options.

Because silicone implants are prefilled, they require a slightly large incision to place them under your breast.

In your situation, an inframammary incision would be a reasonable option. This scar is usually 3-4cm long (< 2 inches) and allows proper placement of the implant. An underarm incision for a 350cc silicone implant may need to be fairly large and would be evident when you lift your arms.

The inframammary incision (and the areolar incisions) are hidden in a bathing suit. Make sure to ask about these incisions under the breast as well. (David Bogue, MD, Boca Raton Plastic Surgeon)

Breast augmentation incisions: the pros and cons

There are several different types of incisions for breast augmentation, and there are pros and cons to each. Each surgeon has their own preferences so it’s important to understand that in general there is no absolute right or wrong answer. The armpit incision is used by some folks because it does not leave an incision on the breast mound itself – this is the main advantage of this approach.

However, there are some disadvantages, including 2 big ones in my opinion: one, the biggest risk with this approach is that the implant does not sit properly at the cleavage line, which is the most cosmetically sensitive area. This happens sometimes with this approach because the incision is a long way away from the cleavage line, making it harder for the surgeon to control the pocket there. Second, it’s important to note that no implant is guaranteed to be permanent – in other words, at some point in your life you may need a revision procedure (if the implant leaks, moves, develops a contracture, for example) and this revision in most cases cannot be done through the armpit, so you would need an incision on the breast anyway.

The other two standard breast augmentation incisions include one in the areola and one place in the breast crease. Both can work well and can heal well with time, and the pros and cons of the two are similar. I personally prefer the areolar incision because I feel it fades very nicely in most cases, but also it is a part of the incision that we would use in case you needed a lift at some point in the future. Talk with your doc about your options, but I think based on your photo, an incision in your crease would be a reasonable option. (Shahram Salemy, MD, FACS, Seattle Plastic Surgeon)

Incision for Breast Augmentation

The three typical incision locations for breast augmentation are inframammary fold, periareolar, and underarm. The usual preferred location by most surgeons is the inframammary fold for several reasons. That location allows for direct access to the implant pocket with excellent visualization for the surgeon, it keeps the incision off of the breast preventing injury to the breast tissue and ducts, it is typically well-hidden, and it can be used for any future surgery related to the implants. Most women do not mind the small incision under the breast. Discuss your options with your surgeon. Breast augmentation incisions placement depends on many factors (Nicholas Tarola, MD, Nashville Plastic Surgeon)

Breast Augmentation Incision Site Selection

There are many opinions as to the best incision site for breast augmentation. I think that most surgeons make their incision based on their experience. Unfortunately, most surgeons have only experienced one or two incision sites during their training and their professional career.

I have used the periareolar, inframammary fold, and transaxillary sites on many occasions and make the decision based on multiple factors. In order to use the incision, you have to have experience with re-operative surgery, as well as silicone and saline implants.

Typically for a patient who has no breast droop, no well-defined inframammary fold, and a small areola, the transaxillary approach is most commonly used. The incision is well hidden in the crease under the arm in the hair-bearing area of the armpit.

Rarely will you be raising your arms high enough for that scar to be noticed. The scar heals very well and will not be typically recognizable within 6 to 12 months. An incision along the inframammary fold will be very visible in a women with no well-defined crease in a string bikini that could ride up. In addition, larger implants can be placed through an underarm incision, as the skin under the arm is very flexible. A small incision can be made and the incision expanded with retractors to allow a large implant to go in.

When the retractors are removed, the incision shrinks back to it’s size when cut and can be closed with as little as a 1-inch to 1½-inch resultant scar. A silicone implant placed through an inframammary fold incision generally requires a large incision, as the skin in this area is not as flexible.

If your surgeon states that he or she cannot place an large silicone implant though the underarm, that means they have very little or no experience with this. Of the three incisions, the inframammary fold gets more complaints in my practice than any incision. Most of my patients are wearing bikinis and when they raise their arm up or lay on their back, the scar is invisible.

The periareolar incision receives the second most frequent complaints. The underarm incision receives the lowest number of complaints. Even with your arms held up, very rarely do people examine your underarm. (William R. Burden, MD, Pensacola Plastic Surgeon)

Underarm breast augmentation

Breast augmentation can be done in several ways. The most common and popular approach is via inframmary crease line.

The second way is through the areola. The third way is through the axilla. The fourth way is through the belly button in case of saline implants.

Introducing the implant via crease line or areola offers the most direct way to visualize the implant pocket as well as to place the implant.

However, if your surgoen is well experienced in underarm approach, she/he should be able to place the implant without damage to axillary vessesl/nerves/lymph nodes.

Please talk with your plastic surgeon to discuss the pros and cons of each approach. (Sugene Kim, MD, FACS, Houston Plastic Surgeon)

Breast augmentation incision under the arm

Breast augmentation can be performed with a axillary incision but there are some limitations and trade-offs with this incision. As recently as this past month, an article was written in the Journal of Aesthetic Surgery in which the authors wrote that there is probably no risk of compromise to the lymph node drain but more research is needed.

Also future surgeries may need to be performed through one of the breast incisions if there are capsule problems or rupture. I prefer the under the breast incision because the incision is well hidden and the approach is very precise. (Elizabeth S. Harris, MD, San Antonio Plastic Surgeon)

Breast Augmentation Under Arm Incision

We offer three incision sites at our practice when using a saline implant. Inframammary (underneath breast), Periareolar (around the nipple), and Axillary (underarm). The incision site is the choice of the patient. Danger to lymph nodes is highly unlikely if the incision is performed correctly. It will be a bit more difficult to lift your arms for the first week or two. Most people heal very well with the incision under the arm. (J. Gregory Kjar, M.D., Salt Lake City Plastic Surgeon)

Breast augmentation

If you are having saline breast implants placed and you have small breasts and no breast ptosis, the axilla or arm pit incision is very good. Your Plastic Surgeon needs to be very familiar with this technique. It has advantages in that there will be no scar on the breast and no dissection of breast tissue is done. It is limiting in that the implant pocket is developed in a closed or blind manor. If your plastic surgeon has experience with this incision – it’s a good one. (Jay H. Ross, MD, Palm Harbor Plastic Surgeon)

If your surgeon is experienced in underarm incision, go for it! It will leave you scarless on the breast. Dont worry about damage to LN, etc – there are risks with all incisions – discuss with your surgeon (Amy T. Bandy, DO, FACS, Newport Beach Plastic Surgeon)

Breast Augmentation incisions

The underarm approach to augmentation is my second choice. I prefer the incision in the crease line below the breast because of its relative invisibility (except when nude). The incision in the armpit area generally heals well but if it happens to heal less than well then it will be visible when you raise you arm while wearing a swimsuit or something similar.

In the end the final decision should be made between you and your surgeon (Deason Dunagan, MD, Huntsville Plastic Surgeon)

Breast Augmentation Through the Armpit

The only advantage to performing an incision through the armpit is to keep the incisions off of the breast. That may seem obvious, but it does not necessarily guarantee that the incision will heal imperceptibly. I would not worry about damage to lymph nodes because they are deeper and more lateral to the incision. Another thing to consider is that if you ever need furhter surgery, whether for a capsular contracture or needing a breast lift down the line, it will require an incision on the breast, thus negating the original advantage of going through the armpit. I perform the majority of my augmentations through the periareolar incision, followed by the inframammary incision. (And I was trained entirely with armpit or Axillary incisions). (Babak Dadvand, MD, Los Angeles Plastic Surgeon)