Incision

Choosing the Location of Your Scar

Dr. Loftus finds that no matter where your incision is located, it typically heals with minimal visibility. However, there are a few fine points to consider.

Incisions may be placed under the breast, around the nipple, under the arm, or through the belly button.

Under the Breast (Inframammary Incision)

An incision under the breast, also called inframammary incision, is the most common incision for many reasons. It is hidden along the natural skin crease, in the shadow of the breast. It often heals inconspicuously and affords the surgeon excellent visibility for surgery. In the rare cases when it heals poorly, it will only be visible when you are wearing no clothing. Women who have asymmetric breast creases before surgery (this is common) should expect asymmetrical positions of their scars after surgery. One of the chief advantages of this incision location is that it allows your surgeon to lower the implants (if needed) while they are in place. This may help your surgeon achieve better breast implant position symmetry. Additionally, as revision surgery is commonly performed through this incision, you will not incur an additional scar when having revision surgery if you start with this incision. Finally, risk of infection is slightly lower when the implants are placed through this incision than through the areolar incision. For all of these reasons, this is the most common location for incisions.

Around the Nipple (Areolar Incision)

An incision around the nipple is designed to camouflage the scar by placing it at the junction of the nipple skin (called the areola) and the breast skin. Typically the incision goes halfway around the areola. Because of the natural color transition in this area, the scar is not easily seen provided that it heals inconspicuously. Many surgeons use this incision, also called the peri-areolar incision, with good results. However, because the nipple is the focal point of the breast, any imperfection, no matter how small, will be obvious. Also, this incision imposes a slightly higher risk of nipple numbness and infection than the other incisions. Finally, because areola size limits incision size, women with small areolas or large silicone implants may not be candidates for this incision, as implant placement might not be technically possible. For these reasons, this incision is less common.

Under the Arm (Axillary Incision)

Using an endoscope (a pencil-sized rod with a fiber-optic camera on its tip), surgeons have achieved good cosmetic results with an incision under the arm, also called the transaxillary incision. Because silicone implants arrive pre-filled from the manufacturer, large silicone implants may be difficult to place through this incision, thereby rendering this incision ill-advised in women seeking large silicone implants. The scar is well hidden when your arms are at your sides. But if the scar remains noticeable after healing, it will be highly visible in sleeveless clothing. It will be especially visible in women with olive or brown skin. It is considered a tell-tale sign, particularly for women who participate in aerobics. Even when this scar heals well, it tends to be highly visible in sleeveless clothing and swimwear.

Through the Belly Button (Trans-Umbilical Incision)

Also called trans-umbilical breast augmentation, or TUBA, placement of implants can be performed through a small incision inside the belly button. It is only an option for saline implants, as silicone are too large to fit through the incision. Also, it is generally used only for subglandular placement, as subpectoral placement through the belly button is fraught with implant malposition and hematomas. Because subglandular saline implants present several aesthetic disadvantages (rippling, wrinkling), many women find this option confers more disadvantages than advantages.

Length of Scar

Because saline implants are filled after they are placed, your surgeon can use a small (1-2 inch) incision. Because silicone are pre-filled by the manufacturer, the incision must be long enough to accommodate the implant 2-3 inches).

Scar Visibility

Usually, scars from breast augmentation fade. Occasionally, they do become wide or unsightly. The final visibility of your scar depends more on your healing process than on your plastic surgeon’s technique. It may take one to two years for your scar to mature.