Summary: Breast augmentation continues to be among the most popular of all cosmetic surgeries. Women who want to increase their breast size and enhance their appearances can choose from many implant types for a look that’s customized to their aesthetic goals. Since 1961 when the first silicone implants were used for breast augmentation, the procedure has become increasingly more refined. There is a wide range of surgical techniques designed to deliver optimal outcomes. One important factor in breast augmentation results is the type of incision your plastic surgeon makes.

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The Different Types of Breast Implant Incisions

In order to place the breast implant in the breast pocket, an incision must be made. The three most common incision options for breast augmentation are the inframammary, transaxillary and periareolar incisions. With the inframammary incision, the surgeon approaches the breast pocket through the natural crease below the breast. A transaxillary incision is made in the armpit and a periareolar incision is made around the outside of the areola. Each of these incisions will result in some scarring, but with proper scar management the incisions can fade to become nearly invisible.

Incision Decisions

It’s normal to be concerned about incisions because you don’t want any scars to detract from your breast appearance. However, incision placement can have a direct impact on the outcome of your breast augmentation. While an experienced plastic surgeon can create beautiful results using a variety of approaches, the best approach for you depends largely on your individual case. Once you’ve made the decision about which breast implants are ideal for you, you and your plastic surgeon can consider the incision placement that is best suited to your needs.

The Transaxillary Approach

Some women are attracted by the prospects of the transaxillary incision because the scar is placed under their armpit rather than on their breasts. However, this incision placement has a few limitations. Because the transaxillary incision is placed some distance from the breast, it’s difficult to achieve the same level of accuracy when placing the implants in the breast pockets. Even with the aid of an endoscopic tool, this approach can result in improper implant placement. Furthermore, in the event of breast revision surgery for any reason, your surgeon will generally not be able to reuse the same incision, instead making an additional incision on or around the breasts to perform revision surgery.

The Periareolar Incision

The periareolar incision can be a good option for some women planning their breast augmentation because the pigmented skin of the areola often allows for optimal scar healing. However, women with small areola are not always good candidates for this incision, as the size of the areola limits how large the implants can be. Additionally, bringing the implant through the areola exposes it to bacteria that is naturally present in the breast tissue, which may lead to a higher rate of capsular contracture than with the inframammary incision.

The Inframammary Incision

The inframammary incision is hidden in the crease under the breast and offers your plastic surgeon the best access to the breast pocket. This allows for a higher degree of accuracy when placing the implant, which can be especially important for women hoping to resolve breast asymmetry with implants. Another benefit of the inframammary incision is that the same incision may often be reused in the event of future breast revision surgeries. Placing the incision under the breast crease often translates into better long-term results for women who have breast augmentation.