Breast Augmentation, What You Need to Know Volume 3: Incisions


Breast augmentation has overtaken liposuction as the most commonly performed cosmetic procedure in the United States.  In my San Diego practice, breast augmentation also leads the way as the most requested.  I am embarking on the third installment in the Breast Augmentation What You Need to Know series – incisions.

There are several incisions commonly employed for the placement of saline and silicone breast implants: around the nipple, breast crease and axillary – (belly button incisions are also employed, but I do not use this technique because of the high rate of problems associated with this approach).  Each of these incisions has different benefits and limitations, which we will discuss below.

Periareolar (nipple) incision:  

This incision is one of the most common approaches that patients request in my office.  The incision is located at the junction between the pigmented areolar skin and the lighter breast skin. It usually extends from approximately 3 o’clock to the 9 o’clock position.  This incision tends to heal well and is easily camouflaged in the natural color change that exists in this location.  This incision is well concealed in any clothing or bikini and does not run the risk of exposure.  It does sit on the most prominent aspect of the breast, but is well hidden as a result of strategic placement.  If the areola is very small, it may be difficult to place a silicone implant because these implants are pre-filled.  This, however, is rarely a concern and I can give you additional information at the time of the consultation.  Studies have shown that the incidence of nipple sensation changes after surgery is equal to that of the breast crease approach.


Inframammary (breast crease) incision:  

This is as frequently requested as the periareolar approach and one I feel equally comfortable with.  This allows direct access to place the implant in either location (above or below the muscle) and avoids any scarring on the breast itself.  This allows the breast proper to remain without any scarring, but there is a scar seen underneath the breast itself.  This could be seen in a bikini if the lower edge rides up inadvertently.  The scar is a straight line and there is no limitation with a patients’ particular anatomy.  With most women, the augmentation procedure will help to create a fold underneath the breast, even if one does not exist prior.  This will help hide the incision in a natural fold making it invisible from a frontal view.  As previously stated, the incidence of nipple sensation changes is equal with a peri-areolar approach.

Axillary (armpit) incision:

The axillary approach avoids any scarring on the breast whatsoever which is attractive to many patients.  There are several issues with the procedure itself.  The surgery requires endoscopic equipment and is further away from the most important cosmetic areas of the breast.  This makes the surgery technically more challenging and often less effective.  The goal is not to limit scar but to achieve a naturally beautiful breast.  If there is any problem or need for revisions, it is almost certain that you will need to have a separate new breast crease or areolar incision.  Also, the placement of silicone implants through the axilla is not recommended as the scar becomes longer and thus more visible.  Also, women in tank tops, sun dresses or bikinis run the risk of unwanted exposure of the scar with their arms raised.

Umbilical (belly button) incision:

This technique was designed to address all of the problems with the above techniques. However, the surgery is performed with absolutely no visibility whatsoever and has the highest complication and revision rate of any of the above approaches.  As a result, I do not even offer this as an option to my patients as I don’t feel that this is a reliable surgical technique.

In summary, 90-95% of women who undergo a breast augmentation will likely have their implants placed through a breast crease or areolar incision.  These surgical approaches have led to many extremely happy women who wonder why it took them so long to finally decide to go forward with their desire for larger, fuller breast – stay tuned for our final installment: size.


About the Author:

Dr. Vince Marin is a San Diego board-certified plastic surgeon specializes in cosmetic surgery of the face, nose, breast and body. If you wish to contact Dr. Marin, write to [email protected] or you can follow him on Twitter!