One of the decisions to be made when choosing breast augmentation is where to place the incision. I offer my patients the choice of an incision underneath the breast (inframammary), within the areola (periareolar), or in the axilla (axillary). Of course some women require a breast lift along with their breast augmentation; for these women one would place the implants through the mastopexy incision.

The inframammary incision is covered by all types of clothing and swimwear, is associated with a low incidence of change in nipple sensation or ability to breast feed. In women who have a mature shape to their breasts (a more full lower breast) the incision will usually be hidden by the shape of the lower breast. When standing in front of a mirror topless the incision will usually be tucked into the crease of the breast and not seen. The skin of the lower breast is thicker that the skin of the areola, therefore there is a slightly increased risk of unfavorable scar formation with the inframammary incision.

The periareolar incision is also covered by clothing and swimwear. Because the areolar skin is thin, this incision heals very favorably. Many women are concerned that the periareolar incision is associated with a higher incidence of change in nipple sensation than the other incision locations. I have not experienced this in my practice and a recent journal article supports this viewpoint.

There is a slightly higher risk of interference with breast feeding with the periareolar incision and this, not change in nipple sensation, is in my opinion the drawback to the periareolar incision. For women without fullness in their lower breast, the periareolar incision can be better hidden when topless than can the inframammary incision.

The axillary incision has the advantage of not being on the breast. The incision is not covered by sleeveless clothing or swimwear; however, the incision is high in the axilla and difficult to see. The incidence of implant malposition, or the implants riding too high, is highest with the axillary incision.

I find that the recovery time is a bit prolonged when using the axillary incision. The axillary incision is often not able to be used in secondary or revision cases. However, the axillary incision is associated with a very low rate of change in nipple sensation and interference with breast feeding and many women prefer to not have an incision on their breast.

In my practice I find that there is no difference in the patient satisfaction rate amongst the three incision locations. Occasionally, based on the patients' anatomy and size of implant that she wants, I will suggest to a patient that she strongly consider one incision over the others. Usually, however, she and I review the pros and cons of each incision and she chooses the incision that best suits her aesthetic and personal goals.