Breast Augmentation Incisions: Transaxillary, Periareolar, Inframammary, TUBA

There are four common incision locations for a breast augmentation, and each has its own pros and cons. Let's walk through all of them — including which one I prefer, and why.

Where: In a natural fold of the armpit (axilla).

• The scar is away from the breast itself
• When you stand in front of a mirror, you don't see a scar on your chest

• The scar is very visible in tank tops, sleeveless dresses, and bathing suits
• It's in such a specific location that it essentially announces you've had a breast augmentation
• I have surgeons in conferences show photos and tell us "look, the scar is invisible." My eye goes straight to it every single time. You can always see it if you know where to look.
• Higher risk of capsular contracture and infection compared to other incision locations
• Because it's a small incision, far from the breast, and requires tunneling, it can be challenging to safely place modern (and especially larger) silicone implants

This is not my preferred incision, even though some patients are drawn to it because of the "no scar on the breast" appeal.

Where: Along the lower half of the areola, where the pigmented skin meets the regular breast skin.

• The scar often heals beautifully along the natural color transition between the areola and the breast skin

• It's still visible when you look in a mirror
• Higher risk of capsular contracture and infection compared to the inframammary
• The implant is placed by going through the breast tissue itself — which can mean:
  • Decreased nipple sensitivity afterward
  • More potential issues with breastfeeding
• Limited by your areola size — if your areola is on the smaller side, it can be difficult to fit a larger silicone implant through that incision

This one's a fine choice for some patients but trades off some real things — especially if breastfeeding or sensation matter to you.

Where: In the inframammary fold (IMF), the natural crease where the bottom of the breast meets the chest.

• Lower risk of capsular contracture and infection than transaxillary or periareolar
• It's the preferred incision for complicated revisions, which I do a lot of in my practice
• When you look at yourself in the mirror, the scar is hidden up under the breast (if it heals in the right location, the breast itself camouflages it)
• Excellent access to the implant pocket — easy and safe to place implants of essentially any size

• If the incision doesn't heal in the right place — say, drifts up onto the breast itself rather than staying tucked in the fold — it can become visible

For most augmentations, and especially for any patient who I think might end up needing a revision down the road, this is the one I reach for. It's clean, it's hidden when it heals well, and it gives me the best surgical access.

Where: A small incision inside or around the belly button. The implant is tunneled up through the abdomen to the breast pocket.

• Blind technique — using long instruments to spread tissue and place the implant by feel, or
• Endoscopic technique — using a small camera to visualize the path and pocket

• The scar on the breast is non-existent
• Visible scar is only at the belly button, which is generally easy to hide

• The belly button is not exactly known as an infection-free location — it's a deep, moist crease that holds bacteria
• You are tunneling implants through abdominal tissue — which is challenging or not possible for silicone implants of any decent size (saline implants are placed empty and filled, so they tunnel easier)
• If your surgeon is doing this without an endoscope, there's a meaningful chance the implant ends up in the wrong place anatomically — for example, ending up over the muscle when the plan was under the muscle

This is a less commonly used option, and I'd be very cautious about a TUBA done without endoscopic visualization.

Quick note: all four incision types can be used for revision surgery. But for complicated revisions, the inframammary incision is the easiest by far — it gives the surgeon the most direct access to the implant pocket, the capsule, and the chest wall structures we may need to work on.

If you have a periareolar or transaxillary incision from your original surgery and end up needing a complex revision, your surgeon will often add an inframammary incision to make the revision safer and more thorough.

Incision	Visible in Mirror?	Contracture/Infection Risk	Big Silicone Implants?	Revision-Friendly?
Transaxillary	No	Higher	Difficult	Limited
Periareolar	Yes	Higher	Limited by areola size	Limited
Inframammary	Hidden if it heals well	Lower	Yes — easy access	Best
TUBA (umbilical)	No (on breast)	Higher infection risk	No (saline only, really)	Very limited

If you're consulting for a breast augmentation, my strong preference for most patients is the inframammary incision — lower risk profile, easier surgical access, the best option if you ever need a revision, and the scar is genuinely hidden once it heals well.

The other incisions all have real trade-offs, and they're worth understanding so you and your surgeon can match the right incision to your goals, anatomy, and the type of implant you want.