Understanding Breast Augmentation Incisions – Which Is Right for You?

There are four main options for breast implant incisions. Implants can be inserted through incisions around the nipple (periareolar incision), under the breast in the inframammary crease (inframammary incision), in the armpit (transaxillary incision) and via the belly button or navel (transumbilical incision).

The choice of incision pattern for your breast augmentation depends on your surgeon's preference or training, your anatomy, your goals and the type and size of your breast implants.

For example, only saline-filled breast implants can be placed via a transumbilical incision.

Transumbilical Breast Augmentation (TUBA) Incision

The transumbilical breast augmentation (TUBA) incision is usually J- or C-shaped and stays hidden within the folds of your belly button. It is often considered "scarless" because the scars are hidden.

TUBA is performed using a flexible tube that has a small camera on the end of it (an endoscope). An image is sent to a TV screen so the surgeon can visualize the procedure. Tiny instruments are also inserted. After making the incision, the surgeon uses these instruments to make two tunnels to the areas under the breasts. He or she then creates two pockets using tissue expanders — silicone shells similar to breast implants that are inflated to create the pocket and then removed.

With TUBA, breast implants can be placed either under or over the chest muscle. TUBA often involves a lower risk of infection, a shorter surgery, and a quicker recovery than with other breast augmentation incision patterns. There are no incisions on or around the breast with TUBA so there is no risk of losing sensation in this area from nerve damage.

There are some trade-offs though.

Only saline-filled breast implants can be placed via TUBA as these implants are inflated once placed in the pocket. Pre-filled silicone gel implants are too big to be placed through the small TUBA incisions. The TUBA incision is created far away from the actual implant site, which can mean a greater margin for error.

A)
tuba incisions diagram

B)
transumbilical breast augmentation scar photo

A) The TUBA incision and the endoscopic tunnels (or tracks). The red spot is the incision in the navel and the blue lines running from the navel to the breasts are the endoscopic tunnels used for placement of the implants.

B) TUBA incision after healing.

Inframammary Incision

Placing the incision in the crease under the breasts, slightly above where the breast and rib cage meet, is known as an inframammary incision. It is very popular with surgeons. After the incision is made, the surgeon creates the pocket either under or over your chest muscle.

crease breast implant scar photo
Diagram showing inframammary incisions

crease breast implants incision diagram
inframammary incision scars

For some types of implants, an inframammary scar may be only 1 to 1.5 inches wide. Smooth, saline breast implants can be put in with very small incisions, while textured or silicone gel-filled implants need slightly longer incisions.

Periareolar Incisions

A periareolar incision is made between the pink or brownish skin that surrounds your nipple (the areola) and the regular skin of your breast. This type of incision is a good choice for inserting breast implants if you are also having an areola reduction or certain types of breast lifts.

There is a small chance of decreased nipple sensation with areolar incisions, but this is usually temporary. You also may be more likely to experience difficulty breast-feeding with periareolar incisions. This is an important consideration if you are thinking about having children. If you choose the periareolar incision and become pregnant, you might also want to consult with a lactation specialist if you decide to breast-feed.    

A periareolar incision also carries an increased risk of a staph infection compared to the other breast implant incisions, because staph bacteria can be found in the milk ducts of the nipple. These ducts may be cut during this type of insertion.

Transaxillary (Armpit) Incision

A)
periareolar incision diagram

Breast implants can also be inserted through incisions in the armpits (transaxillary incisions). Inserting breast implants this way can be done endoscopically. The surgeon creates tunnels to the sites where the breast implants will be placed. Usually, transaxillary incisions are between 1 and 1.5 inches long, depending on the type of implant. Some surgeons consider this to be the best incision for full submuscular placement.

 

The diagram shows the incisions in the armpits and the endoscopic tunnels (or tracks) as blue lines.

The transaxillary breast augmentation incisions six weeks after surgery.

transaxillary breast augmentation scar photo

Just as with implant placement, and implant type and size, breast implant incision patterns should be discussed during your initial consultation with a board-certified plastic surgeon. Ask your surgeon what he recommends for your surgery, and why.

 

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    Ronald H. Schuster, MD

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