One of the choices that you will make regarding breast augmentation surgery is the location of the incision through which the surgery is performed.  If you are worried about this choice, I have some good news.  For the vast majority of patients, an expert surgeon can provide an equally beautiful result through any of the commonly used incisions. 

What really counts with breast augmentation surgery is that the plastic surgeon creates an accurate space for the implant, properly controls the shape of the lower pole of the breast, selects the right implant for your body type, and has the experience to recognize subtle issues of breast contour that must be addressed at the time of surgery.  The skill and experience of the surgeon is of far greater importance than the choice of incision.

That said, there are some circumstances where a particular choice of incision for breast augmentation surgery may have an advantage.  Here is what I have learned from the several thousand patients in whom I have placed breast implants.

There are three main choices for incisions in breast enhancement surgery: the inframammary incision is located in the natural fold beneath the breast, the periareolar incision at the lower edge of the areola, and the axillary incision in the armpit area.

Breast augmentation via an inframammary incision provides direct access to the important lower pole or curvature of the breast.  This incision has particular advantage when the surgeon must address complex issues of breast shape.  The scar tends to hide quite well in the natural shadow of the inframammary fold.

Breast augmentation via a periareolar incision can be a good choice for patients of African or Asian ancestry if there is a personal or family history of thick scars.  The areola is one of the privileged zones of the body where formation of a thick scar is unlikely. This advantage is offset by the potential for greater interference with breast feeding, as suggested by some papers in the lactation literature.

Breast augmentation via an axillary incision has the advantage of moving the incision away from the breast.  This also imposes some disadvantage from a technical standpoint, since it is harder to address complex issues of breast shape through this approach.  When I perform axillary breast augmentation I use an endoscope, which allows me to carry out this surgery with precision.  Please remember that this is not “scarless surgery.”  The scar is simply moved from the breast to the area under the arm.  If you play sports in which you bring your arms over the head, such as swimming, volleyball, or tennis, the location of the scar may be an issue.

You can find greater details about each of these approaches in additional blogs in this series.