Breast Augmentation: Cost, Reviews, Photos

Getting a silicone gel implant through a small nipple incision is difficult and generally leaves the nipple looking scarred and distorted.

The other traditional routes are the underarm or inframammary crease both of which are acceptable and can give you a pretty result.

Placing the implant through the underarm should best be done with an endoscope.

Otherwise the cavity is created blindly and you are prone to postoperative bleeding and implant malpositions.

The inframammary incision is the most common and probably the easiest.

In a well – performed breast augmentation your incisions should be faint and should fade with time. I am certain that you will have a good outcome. (Mark E. Crispin, MD, Atlanta Plastic Surgeon)

Armpit Incision for Breast Augmentation

Incisions in the armpit are a placement for those patients who do not want a scar on the breast. However, only saline implants can be placed through an armpit incision. (David L. Robbins, MD, FACS, West Des Moines Plastic Surgeon)

Armpit vs areolar incisions breast augmentation

Scars in the axilla are typically better and fade better than in most other areas of the body. Plastic surgeons refer to better scarring locations ( the axilla, the groin, the eyelids etc) as “favoured”. Without there being any guarantees, typically a scar in the axilla will fade to the point of being near invisible, regardless of whether you hold your arms up dancing exercising etc or not.

But as another doctor has posted, experience and familiarity with the technique is necessary, and I strongly advocate endoscopically assisted rather than ” blind” development of the space, as well as the use of insertion funnels when gel implants are used.As a plastic surgeon who has since 1997 done several thousand augmentations through the armpit with endoscopic assistance, I strongly advocate this approach vs. the areolar incision.

In recent years, in addition to the clear advantage of the scar being in a location completely off the breasts, some other advantages have become clear through studies that have published: Areolar incisions are now felt to be associated with a higher risk of low level contamination from bacteria which are normally resident in the ducts of the breast.

So much so that some plastic surgeons routinely cover the nipples with plastic shields during surgery. Areolar incisions are associated with higher risk of loss of feeling to the nipple than traditional under the breast incisions and axillary ( armpit) incisions. Technically it is sometimes difficult to do a areolar approach if the areolar diameter is small.

One of my very first trans axillary cases was just such a situation and I was amazed at how much easier the procedure went, even though it was new to me, than it would have had we used an areolar approach. (Benjamin Gelfant, MD, Vancouver Plastic Surgeon)

Armpit Incision for Breast Augmentation

The armpit incision for breast augmentation ( trans-axillary approach) is a great option if done properly. Axillary scars heal very well and are often much less visible than anything on the breast or in the infra-mammary fold. There is a relatively new device, called the Keller Funnel, that allows surgeons to insert gel implants easily through the armpit, using small incisions and not damaging the implant.

I use this on all of my silicone gel cases, and the results are excellent. You should discuss this with your surgeon. Choose the right surgeon – your scar will be barely visible no matter where it is (Steven L. Ringler, MD, FACS, Grand Rapids Plastic Surgeon)

Every surgeon has their preference for implant placement. I prefer the dual plane technique. I’ve attached a video for more information on the dual plane technique.

I know it gets very confusing with all the options. Best thing to do is to review each board certified PS’s before/after photos. Go with the results that you like the best. (C. Bob Basu, MD, FACS, Houston Plastic Surgeon)

All doctors have different bedside manners as well as different approaches to how they do surgery. I like to place implants smooth round under the muscle.

Saline or silicone fine for you in my opinion. A 400cc high profile a reasonable choice. The goal of surgery should not be to make more cleavage given the shape of your body and breasts.

A moderate plus will give a bit more fullness medial and lateral. The implant center should go behind nipple and the wider the implant the more cleavage but if you do not have thick soft tissue to cover it then it will look bad. You do not have enough tissue for wide implants in my opinion. (Gregory Lynam, MD, Richmond Plastic Surgeon)

You will read many answers from surgeons that will likely always recommend placing silicone implants underneath the muscle. That stems from always placing saline implants under the muscle to give a more natural appearing breast postoperatively. For 15 years saline implants were the only option for women in the United States while the FDA was evaluating the safety of silicone implants (they’re safe by the way). Meanwhile, the rest of the world was using silicone implants and they by and large place them above the muscle, with fantastic results. It has taken the United States a while to catch up. The right implant, in the right location, will give you a spectacular result. I’m happy to see you if you don’t mind driving a bit. Contact me this week for a free consultation. (William A. Wallace, MD, FACS, Jacksonville Plastic Surgeon)

You would be a candidate for a dual plane augmentation in my opinion. However, without an exam it is difficult to say what is best for you. With dimensional planning, you should get a nice result regardless of the plane chosen for the surgery. (Mark P. Solomon, MD, Philadelphia Plastic Surgeon)

Implants over or under the muscle

It is generally recommended and accepted that most breast implants should be placed under the muscle. This location provides for better tissue coverage over the implant and has a lower incidence of capsular contracture and rippling. (Diana Breister-Ghosh, MD, San Diego Plastic Surgeon)

I would favor under the muscle, which is usually my preference. Better reassurance will come from your scheduled in person consultations. (Jourdan Gottlieb, MD, Seattle Plastic Surgeon)

Placement of breast implants

After you see your other surgeons, trust your instincts and choose the one you feel most comfortable with. And if you don’t like any of them, by all means look for another surgeon.

This is your body and you should only proceed with surgery if you’re totally comfortable. Implant placement depends on a variety of factors, including breast measurements and your expectations. (Jerome Edelstein, MD, Toronto Plastic Surgeon)

Continue with your consultations until you find a surgeon you are comfortable with. Viewing before and after photos at the clinics can help you to determine various methods and work. (Martin Jugenburg, MD, Toronto Plastic Surgeon)

Most of my patients are under the muscle mostly because it’s better for mammograms and going under the muscle gives more coverage of the implant. Also as time moves on, if you are above the muscle, your implant will move down with your breast tissue and may leave you with no upper pole fullness which most of my patients are hoping to get back with their augmentation. If you are still unsure with this surgeon, I would recommend going on another few consults until you find a surgeon who you are comfortable with or see that surgeon for a 2nd consultation so you can ask more questions. (Angela Champion, MD, Newport Beach Plastic Surgeon)

Implants over or under the muscle

It appears that you have a choice of going over the muscle or under the muscle. If you were to choose to go over the muscle, I would recommend a silicone gel implant as implants over the muscle have greater risk of palpability and rippling vs. implants in the submuscular position.

If you choose submuscular, I feel that saline or silicone implants would be fine. I believe that measurements are critical in determining the correct implant for any patient. (Christopher J. Morea, MD, Raleigh-Durham Plastic Surgeon)

Silicone implants and incision choice

If the smallest and most inconspicuous scar is your goal, you may want to consider a saline implant.

If you are determined to have silicone, then one of the tradeoffs is that for the same size implant, it unfortunately requires a larger incision.

Likewise, placing silicone implants via the axillary can be difficult making the outcome less predictable.

If you are not totally satisfied with the recommendations from your consultation, it is prudent to obtain at least one more formal consultation to get a 2nd opinion and you can then go with the surgeon that you feel has the best plan to meet your needs. (Bryan Correa, MD, The Woodlands Plastic Surgeon)

Axillary Incision for Breast Augmentation

Each surgeon has his or her preferences for surgery. I am not a fan of the axillary incision especially for my patients living in South Florida. In similar cases to yours, my preference has been a small nipple-areola incision possibly with a use of a device known as a Keller Funnel.

Your surgeon’s recommendation is reasonable and if that is consistent with his or her normal procedure then would be viable. (Kris M. Reddy, MD, FACS, West Palm Beach Plastic Surgeon)

Incision Location When the Areola is Small

In your case, I agree the peri-areolar approach is not to be considered with silicone implants, or possibly even saline implants.

Nipple numbness would a significant risk with this approach it it was even possible to insert the implants. The transaxillary endoscopic approach with silicone is possible, but would require a fairly large incision in an oft-seen area if silicone implants were used.

For scar concealment and least risk of potential nerve involvement, the inframammary approach would likely be the best placement for silicone implant placement for the size you are considering, and with the small amount of “overhang” (ptosis) created the scar should be quite inconspicuous. (Scott A. Brenman, MD, FACS, Philadelphia Plastic Surgeon)

Axillary Incision for Breast Augmentation Because Nipples Are Small?

With any technique you will get a scar. With axillary placement you will have a scar that might show when you raise your arms. With inframammary placement you will get a scar on your breast. It is more common to use the inframammary incision for breast implant placement. I agree that if you need a revision surgery you would need a periareolar or inframammary incision. (Jon E. Rast, MD, Kansas City Plastic Surgeon)

Axillary Incision for Breast Augmentation Because Nipples Are Small?

The placement of the incision for breast augmentation is dependent on many factors including both the surgeons and the patients preferences along with other factors including anatomical variations (nipple size, inframammary fold position etc) and desired size of the implant. In modern day plastic surgery the most common incision placements include the inframammary fold and periareolar and less commonly axillary and transumbilical.

There are many reasons for this shift but ultimately they come down to better and more reliable results with less complications. I would need to measure your areolar size to assess if they are suitable for a periareolar incision but your other option would be an inframammary fold incision. You look like a great candidate for a breast augmentation and should achieve a lovely result. (Guy Watts, MBBS (Hons), FRACS (Plast), Perth Plastic Surgeon)

An Inframammary Approach is a Great placement for Patients with Small Areolas

In a woman with small areola, a periareolar incision may not be acceptable for silicone breast augmentation. Under these circumstances, other alternatives should be considered for this procedure.

There are currently three placement of incisions used for silicone breast augmentation surgery. These include the periareolar, transaxillary, and inframammary approaches.

All three of these incisions have advantages and disadvantages when used for this procedure. When choosing an breast implant incision, most women’s primary concern is usually scarring.

All three incisions are associated with scarring to some degree, but the impact of this scarring is dependent upon the patient’s lifestyle. For this reason, the breast implant incision should be based on the individual patient’s needs.

For instance, a transaxillary approach might result in highly visible scars in a sand volleyball player who brings her arms over her head and therefore may not be the best option in this patient. In the majority of patients who have small areola, we prefer an inframammary approach. This incision is nicely hidden when wearing most types of clothing.

In addition, it separates the muscles from the chest wall along the inframammary fold which allows for a more natural look.

The choice of breast implant incision in most cases is decided by anatomic findings in combination with personal lifestyle choices. In your case, your areola are too small for a periareolar incision and you are fearful that people will be able to see a transaxillary incision. In your case, an inframammary incision seems to be your best option. (Richard J. Bruneteau, MD, Omaha Plastic Surgeon)

Best breast implant incision for Breast Augmentation

In experienced hands only do I think the axillary approach is a good placement , but there are limitations to this approach as with any approach. The inframammary scar is a great option for those whose areolar size will not accommodate a nipple breast implant incision. If you do the axillary approach, make sure your surgeon has performed a large number of these procedures to master the various nuances associated with it. (Brian Howard, MD, Alpharetta Plastic Surgeon)

Armpit incision for breast augmentation

As you know, there are several factors to consider for breast augmentation – implant type, incision location, placement of the implant, and size/projection of the implant. You have valid concerns regarding your breast augmentation. I find that it is difficult to place that size of a silicone implant, or larger, through an axillary (armpit) incision. Also, dissection of the pocket sometimes is difficult without visualization, in order to perfectly create a pocket for your implant. I would guess that a larger breast implant incision of 4-5cm would be necessary for placement of your implant.

Depending upon your concerns or activities that you participate in, the incision may not be inconspicuous. This is a nice method for breast augmentation, however, with the aforementioned limitations. You may consider an inframammary incision, as direct visualization is possible, the incision is hidden within your inframammary crease and within bras/bikins.

In my hands, aesthetic results are better because of the direct visualization itself and concealment of the incision. While possible, I agree that a periareolar incision may not be the wisest choice for you. (Lewis Albert Andres, MD, Scottsdale Plastic Surgeon)

Armpit incisions for breast augmentation

Breast implant incision placements for a silicone implant are 3: armpit, areola and below the breast (inframammary). The size of the incision is really dictated by the size of the implant. The larger the implant, the larger the incision.

For the smallest possible incision, a saline implant is needed. To get a larger silicone implant through the armpit, a lengthy incision will be needed (4-5cm) and will be more noticeable.

For the most hidden incision with nearly all clothes, an IMF incision is likely your best option. (Brian C. Reuben, MD, Salt Lake City Plastic Surgeon)