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Breast Implants Incision Placement Choices

There are several options in breast implants incisions. The implants can be inserted through incisions around the nipple (periareolar incision), under the breast in the inframammary crease (inframammary), under the arm in the armpit (transaxillary), and in the belly button or navel (transumbilical).

Although many patients wish it were so, you cannot always pick which breast implants incision placement you’ll have. The choice of incision depends on your surgeon's preference or training, and your particular needs or desires as a patient.It also depends on what kind and breast implant size you are getting.
For example, a transumbilical breast augmentation incision can only be done with a saline implant. For another example, a textured implant may not be appropriate with a smaller, endoscopic incision. In general, silicone gel-filled implants require a slightly larger incision than saline filled implants, which can be put in place empty and then filled.

Smooth shell implants can easily be placed using a breast implants incision only an inch in length under the arm or breast and an even smaller incision through your navel.

If you are getting very large implants and your skin is not very elastic, you may need a transumbilical or transaxillary breast augmentation so that the incision is not severely stretched by the implant. An inframammary and periareolar incision may be stretched too much with a large implant, which can result in greater breast imlpant scars. Even worse, if your natural crease (where your breast meets your chest underneath) needs to be lowered, an inframammary scar may not be hidden in the crease if your surgeon does not accurately predict the new crease location or if the crease moves down faster than expected.

A widened scar can also occur with a mastopexy (breast lift) or areolae reduction with breast augmentation. If you are getting a breast lift and/or areola reduction at the same time as implants, the increased pressure on the skin due to the implants can force the scar to widen and enlarge. Normally, paper tape such as Steri-Strips will be used to help with scar healing in general. Steri-Strips usually speed up the healing of the scars, as well as keep them flatter and support the breast implants incision lines.

Transumbilical Breast Augmentation, Belly Button or TUBA Incision

The TUBA, or transumbilical breast augmentation, technique is done using endoscopic instruments, which include fiberoptics and cameras that allow the surgeon to see what he or she is doing. The TUBA incision is shorter than an incision near the breast or under the arm due to the greater elasticity of the skin on the abdomen. The incisions are usually J shaped or C shaped and they stay hidden within the folds of the navel. After making the incision, the surgeon uses an endoscopic device to make two tunnels to the areas under the breasts and creates two pockets using tissue expanders, which are silicone shells similar to breast implants, but which are inflated to create the pocket and then removed.

With transumbilical breast augmentation, implants can be placed either under or over the muscle. TUBA often involves a shorter recovery time in comparison to other incisions.


Here is a diagram showing the TUBA incision and the endoscopic tunnels (or tracks) as well as a photo of the belly button after healing. 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.

Inframammary or Crease Breast Implants Incision

Placing the incision in the crease under the breasts, a little above where the breast and rib cage meet, is very popular with surgeons. It is widely used because it is an easy insertion and the cosmetic surgery can be done quickly. An inframammary incision is a good one to use if there might be any difficulty in getting the implants symmetrical. After the incision is made, the surgeon can create the pocket either under or over the muscle.

crease breast implant scar photo

crease breast implants incision diagram

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 take slightly longer ones. With care, the scars will heal flat and are frequently almost imperceptible after a few months, but a lot depends on how well you skin heals. Some people, notably smokers, do not heal as well as others.

Here is a diagram showing inframammary incisions, as well as a photo of healed breast implant scars.

Inframammary Incision Scars

Breast Augmentation with Periareolar Incision

A periareolar incision is made at the border between the pink or brownish skin that surrounds your nipple (the areolae) and the regular skin of your breast. A periareolar incision is a good choice for inserting breast implants if you are also having an areola reduction or a crescent or Benelli breast lift (see below). With an areola incision, there is a small chance of decreased nipple sensation, but loss of sensation is usually temporary.

There is also a greater risk of future difficulty breastfeeding after breast augmentation with a periareolar incision. This is an important consideration if you are not done with childbearing. If you are considering having more children, or have not yet had any, discuss this factor with your surgeon. If you choose to go with a periareolar incision and become pregnant in the future, let both your obstetrician and your baby’s pediatrician know that you have breast implants inserted through the areolae. You might also want to consult with a lactation specialist.

A periareolar incision also carries an increased risk of a staph infection compared to the other breast implant incisions. This is because staph bacteria can be found in the milk ducts of the nipple, which can be cut during this type of insertion. Some surgeons use a sleeve of sorts to shield the implant from the milk ducts during placement.

Here is a diagram showing a periareolar incision breast augmentation, along with photo of both a patient who had a standard periareolar incision (at only 2 days postoperative!) and one who also had breast implants put in along with a Benelli breast lift, which involves an incision from the nipple to the crease to lift the breast (3 weeks postoperative).

Transaxillary (Armpit) Incision

Breast implants can also be inserted through incisions in the armpits, called transaxillary incisions. Inserting breast implants this way can also 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 inch long, again depending on the type of implant being used. Some surgeons consider this to be the best incision to use with full submuscular placement.

The diagram shows the incisions in the armpits (the short red lines) and the endoscopic tunnels (or tracks) as blue lines. The photo of the transaxillary breast augmentation incisions was taken at 6 weeks postoperative.