If youโre considering breast surgery, itโs natural to have questions about how the procedure will be done and what your scars might look like. One of the most important decisions you and your surgeon will make is where to place the surgical incision. The type and location of the incision can affect everything from how well the surgeon can work to how the scar will look when it heals. At Vitapera Clinic, we want our patients to feel informed and confident about their choices. Below, weโll walk through the common types of incisions used in different breast surgeries and explain their advantages and trade-offs in a clear, patient-friendly way.
Breast Augmentation (Implants) Incisions
For women getting breast implants (breast augmentation), there are a few main options for incision location. Each approach has its own set of pros and cons:
Inframammary (Fold) Incision
This incision is made in the crease beneath the breast (the inframammary fold). It usually follows the natural line where the breast meets the chest wall.
Pros: It gives the surgeon very direct access and excellent visibility to create the implant pocket under the muscle or gland. This direct view makes the procedure more precise and usually faster. Because the scar lies in the breast crease, itโs generally well-hidden, especially when the breasts are supported (in a bra or swimwear). For most implant sizes and types, this approach works very well.
Cons: The main downside is that the scar, while hidden in the fold, will always sit on the breast itself (even if low on the chest). If you have a high breast fold or if your breasts are small, the crease might not hide the scar as well. In some clothing or if the breasts lift, the scar might become visible. Also, in extremely athletic or lean patients, the crease can be less distinct and the scar can be more noticeable.
Periareolar Incision:
This approach places the incision around the lower half (or full circumference) of the edge of the areola (the colored skin around the nipple).
Pros: The scar tends to blend with the natural color change between the darker areola and the lighter breast skin, which can camouflage it nicely. It allows direct access to the breast tissue and pectoral muscle, and is especially useful if only a small implant is needed. Some surgeons feel they can achieve a very neat pocket because theyโre working right where the implant will sit.
Cons: Cutting near the nipple-areola complex means thereโs a slightly higher chance of affecting the nerves that give sensation to the nipple or the milk ducts. This can lead to temporary or even sometimes permanent changes in nipple feeling (it might feel numb, extra sensitive, or different). Thereโs also a small potential impact on breastfeeding, since the incision is very close to the ducts. Additionally, for very large implants or future revisions, the periareolar opening can be a bit restrictive (harder to place a very large implant through this smaller circular opening). And in some cases, the areola can stretch over time, making the scar more visible.
Transaxillary Incision:
This incision is hidden in the armpit (axilla) crease. The surgeon tunnels from the armpit down to the breast to place the implant.
Pros: The biggest benefit is cosmetic: there is no scar on the breast itself. The only scar is in the armpit fold, which most people never see. This appeals to many patients who want to avoid any mark on the breast. Also, because the incision is far from the nipple, it doesnโt affect nipple sensation or milk ducts directly.
Cons: The surgery is technically more challenging. The surgeon works with a mirror or special instruments to create the pocket, so they have less direct visibility than with a breast incision. For this reason, itโs often done with very experienced surgeons and sometimes with endoscopic assistance. It works best with saline implants (which can be filled after placement) or certain pre-filled implants designed for this method, but itโs not ideal for every type of implant. It can also be tricky if future revisions or adjustments are needed, because going back in through the same armpit scar is awkward. Sometimes a second incision (like inframammary) is used for revisions instead.
Transumbilical (TUBA) Incision:
Also called the โbelly-buttonโ approach. In this method, a small cut is made at the navel, and the surgeon tunnels up to the breast to place the implant.
Pros: The main attraction is cosmetic: there are no new scars on the breast or chest at all. The only incision is down at the belly button, which usually heals to a tiny dot thatโs often hidden anyway.
Cons: This approach is relatively uncommon and limited to saline implants. Because saline implants can be rolled up tightly (since they are filled with salt water after insertion), they can be brought through this remote tunnel and then filled. Gel (silicone) implants are not used with the TUBA method. Another drawback is that the surgeon has very limited direct control over shaping the pocket. They are working far from the actual breast, so it takes great skill to ensure the implant settles properly. Because of these limitations, most surgeons only offer it in select cases. At Vitapera Clinic, we typically recommend more direct approaches for the best control, unless a strong case exists for a scarless result.
Overall, the inframammary incision is the most commonly used for implant surgery, given its balance of good surgical access and typically inconspicuous scarring. Many of our patients find theyโre happy with a small scar hidden in the fold. The periareolar approach is a good alternative especially for smaller implants, but we always discuss with patients the potential risks to nipple feeling. If avoiding a breast scar is very important, the transaxillary route is an option โ though itโs more technically demanding and sometimes limited by implant size. The belly button (TUBA) method is rarely used at most clinics, including ours, and only in very specific situations with saline implants.
Breast Lift (Mastopexy) and Reduction Incisions
Breast lifts and reductions involve removing excess skin and reshaping the breast. The amount of sagging (ptosis) and the size of the breast help determine the pattern of incisions needed. Here are the common incision designs:
Periareolar Lift (โDonutโ or Benelli Lift):
This uses a circular incision right around the border of the areola (the pigmented area around the nipple).
Best For: Mild sagging or a small lift. It is often used when only a little extra tightening is needed.
What it looks like: Imagine a donut shape. The surgeon cuts out a donut-shaped ring of skin just outside the areola. Then they pull the skin in and suture it, which lifts the breast tissue a bit and makes the areola slightly smaller.
Pros: The scar is only around the areola, blending into the color change. Because there are no other vertical or horizontal scars, the overall scarring is minimal. Some patients love having just that single round scar.
Cons: Because it only tightens the skin in a small way, it cannot lift a heavily sagging breast. Over time, the areola itself can sometimes stretch and widen, since it was cut and then sewn together. The change is usually minor, but itโs something to consider if very long-term tightness is needed. There is also still a small risk of losing some sensation in the nipple due to cutting around it.
Vertical Lift (โLollipopโ Incision):
This combines the periareolar circle with a vertical line straight down to the breast crease.
Best For: Moderate sagging and when more lift and reshaping is needed than the donut lift can provide.
What it looks like: Picture a lollipop or keyhole. There is a round incision around the areola (the โcandyโ) plus a straight line (โstickโ) from the bottom of the areola down to the inframammary fold. The surgeon removes a wedge of skin and then brings the two sides together, reshaping the breast into a perkier mound.
Pros: It provides much more lift and reshaping power than just the circular lift. Because there is no horizontal scar under the breast, it has less total scarring than the Anchor/โInverted-Tโ method (described next). The vertical scar is usually well-concealed on the lower breast as it heals.
Cons: You will have a scar around the areola and a vertical scar down to the fold. This means two linear scars. In terms of visibility, the vertical scar is longer than just a ring. It can take time to heal and fade, though most patients feel itโs a reasonable trade-off for the improved shape. Thereโs still a small risk of some sensation change near the nipple, similar to the donut lift, since that area is disturbed.
Inverted-T or Anchor Lift (Wise Pattern):
This is the most extensive incision pattern, combining the periareolar circle, a vertical line, and a horizontal line along the breast crease.
Best For: Significant sagging and very large reductions. If a lot of skin and tissue must be removed, this is usually the go-to method.
What it looks like: An upside-down T or anchor shape. The surgeon makes a circle around the areola, a line straight down to the crease, and then a horizontal cut along the fold under the breast. This allows almost any amount of skin to be removed.
Pros: This provides the greatest flexibility for removing tissue and shaping the breast. Itโs often used in major breast reductions or lifts when a dramatic change is needed. Because the horizontal scar lies in the inframammary fold (a natural crease), it is often hidden when the breasts are supported.
Cons: It leaves the most scars: around the areola, vertically down, and along the fold. The benefit is more shaping, but the trade-off is a longer scar. That horizontal scar will always be on the breast (though typically hidden in the fold). Healing can take longer simply because more incisions are present. Still, many patients who need large lifts decide itโs worthwhile to achieve the results they want.
In general, when talking about lifts and reductions, we often say there is a โspectrumโ of incisions: small lift (periareolar only) with small scar, moderate lift (lollipop) with moderate scar, to big lift (anchor) with bigger scar. Your surgeon at Vitapera will examine your breast size, shape, skin quality, and how much lift you desire. Together, youโll choose the pattern that offers the results you want with scarring thatโs acceptable to you.
Mastectomy and Breast Reconstruction Incisions
When breast surgery is performed for cancer treatment (mastectomy) or for reconstruction after cancer, the goals shift slightly. The priority is complete removal of breast tissue for safety, but surgeons also strive to make reconstruction or healing as aesthetically pleasing as possible. Incisions may vary widely depending on the situation:
Elliptical (Longitudinal) Excision:
This is often used for partial mastectomies, where only the tumor and a margin of tissue around it are removed. The surgeon makes an ellipse-shaped cut around the area of the tumor. The exact shape and orientation depend on the tumorโs location. For example, if the tumor is toward the center, the ellipse might go up and down; if on the side, it might curve around.
Skin-Sparing Mastectomy Incisions:
In many mastectomies, the surgeon tries to preserve as much of the natural skin as possible, so that reconstruction (with implants or flaps) can produce a more natural-looking breast. There are several patterns here:
Radial/Curved Incisions: These are curved lines that arc from the breast fold outward, often used to keep scars hidden under the breast or toward the sides.
Periareolar Variations: Some skin-sparing incisions circle partway around the areola and then extend out. This allows removal of breast tissue while keeping skin for a new implant or tissue flap.
Transverse Crease: A straight line along the inframammary fold, preserving the skin of the upper breast.
Sometimes combinations of these are used. The choice depends on where the tumor was and how to best contour the remaining skin.
Nipple-Sparing Mastectomy Incisions:
When oncologically safe (i.e., the tumor is not too close to the nipple), surgeons may be able to preserve the nipple-areola complex. In that case, the incision patterns are designed to leave the nipple attached to the skin. Common patterns include:
Lateral or Radial Incision: A curving cut starting near the armpit or side of the breast, wrapping behind the nipple.
Semi-circular (around half the areola) plus a curve: Sometimes a cut that goes partway around the bottom of the areola and extends outward.
Hidden-incision Techniques: Some surgeons use incisions around the natural pigmented border or small undermining to keep the nipple intact.
Nipple-sparing means the external appearance can be much more natural post-reconstruction, but the incision still needs to be placed carefully. These decisions are highly individualized.
Radical and Modified Radical Mastectomy Incisions:
In cases of advanced cancer, wider excision might be needed. A radical mastectomy (less common now) involves removing the entire breast and underlying muscles and lymph nodes. The incision for that is usually very large, across the breast and possibly extending into the chest wall. A modified radical removes the breast and nodes but preserves muscle, with an incision around the breast that often includes the fold and side. These are determined strictly by medical need rather than cosmetic preference, but skilled surgeons still try to place them as neatly as possible and do reconstruction in subsequent steps.
In any breast cancer surgery, the surgeon will walk you through which incision pattern they recommend. They will explain how it helps ensure complete treatment while also discussing plans for closing and reshaping the breast. Whenever possible, the goal is a straight-line or gently curving scar that can be hidden (for example, under the crease or around the nipple) and that will look more natural after healing. These procedures are very individualized, so there isnโt a โone size fits allโ answer โ but knowing the basic types can help you ask the right questions.
Comparing the Incision Types
You might wonder how these different incisions actually compare in terms of things you care about, like scar visibility, surgical access, and effects on nipple sensation or breastfeeding. Hereโs a quick summary of some key points:
Scar Location & Visibility:
Inframammary: The scar is along the underside of the breast. When standing upright or supported, it tends to hide in the crease. In lying down or loose clothing it might peek out.
Periareolar: The scar circles the edge of the nipple. Itโs usually well-camouflaged because the color difference helps disguise the line.
Transaxillary: There is no scar on the breast itself. The only scar is in the armpit fold, which is easily hidden by your arm.
TUBA (belly button): No breast scar at allโonly a small scar in the navel.
Vertical/Lollipop: Scars around the areola and vertically down the breast. These are on the breast but the vertical line is in a natural-looking location (from nipple to fold).
Inverted-T/Anchor: Scars around the areola, down to the fold, and along the fold. The fold scar is hidden when the breast is supported, but it does exist and circle the bottom of the breast.
Skin-sparing mastectomy patterns: Usually a single curved or transverse scar, often hidden under the breast or around the side.
Nipple-sparing: Various patterns, but often either around part of the areola or along the edge of the breast so that the nipple skin remains intact.
Surgical Access and Control:
Inframammary: Gives excellent access for the surgeon to place an implant or remove tissue. Easy to make a precise pocket.
Periareolar: Good access to the lower breast, but a slightly smaller โwindowโ than inframammary. Fine for moderate implant sizes or tissue removal.
Transaxillary: Moderate access. The surgeon works at an angle, so itโs harder to see some parts of the pocket. Often used for moderate implants, ideally with endoscopic tools.
TUBA: Limited access. The surgeon is working from the belly upwards, so control is reduced. Only suitable for certain saline implants.
Vertical (lollipop) lift: Excellent access for reshaping because of the exposed breast tissue.
Inverted-T: Excellent access (the most) for large removals, since there are two extra cuts.
Mastectomy incisions: Varies by design, but always planned to remove all necessary tissue. Skin-sparing and nipple-sparing incisions aim to preserve external tissue, so the surgeon coordinates removal and reconstruction at the same time.
Impact on Nipple Sensation & Breastfeeding:
Inframammary: Typically minimal impact on nipple sensation, since the nerves to the nipple mostly run through the breast tissue above the fold. Breastfeeding ability is generally unaffected by this incision.
Periareolar: There is a higher chance of affecting nipple sensation because nerves around the areola can be cut during the incision. This can lead to numbness or change in feeling. Also, because milk ducts are near the areola, there is a possibility (though not a certainty) of affecting breastfeeding. Many women still breastfeed successfully, but the risk is slightly higher than with other incisions.
Transaxillary: Lower direct risk to nipple sensation or breastfeeding, since the nipple area isnโt touched. (Though any implant can indirectly affect these through pressure changes, etc.)
TUBA: Also spares the breast, so minimal effect on sensation from the incision itself.
Vertical/Inverted-T (lifts): These do involve cuts around the nipple, so changes in sensation can occur. The vertical lift tends to preserve more sensation than the full anchor, but both can affect feeling because nerves are reorganized when the breast is lifted. Breastfeeding after lifts can be possible, but it depends on how much tissue was removed and how the ducts were rearranged; itโs something to discuss with your surgeon if this is important to you.
Mastectomy: If nipple-sparing, some sensation may remain, but often less than before. If the nipple is removed, obviously there will be no nipple sensation afterward.
In summary, no incision is completely โscar-free.โ However, skilled surgeons like those at Vitapera Clinic strategically place incisions where scars can fade into natural lines (like under the breast or around pigmented areas) and explain to you what to expect. During your consultation, we encourage you to look at before-and-after photos and ask to see typical scar outcomes for each approach.
Choosing the Right Incision for You
With so many options, how do you decide which incision is best? There isnโt a one-size-fits-all answer, but the choice usually depends on several factors:
Type of Procedure: First, consider whether youโre doing an augmentation (implants), a lift, a reduction, a reconstruction, or a combination. Each procedure has its typical incisions: e.g., augmentations often use inframammary or periareolar, while lifts use vertical or anchor patterns.
Amount of Lift or Volume Change: If you need only a small lift or a minor size change, smaller incisions will often suffice. For a dramatic lift or very large implants, more extensive incisions (like the inverted-T or inframammary) might be more appropriate.
Implant Size/Type (for augmentation): Larger implants sometimes are easier to place through an inframammary incision, since the opening can be made bigger and the surgeon can see clearly. Saline vs. silicone makes a difference too: as mentioned, only saline implants can be used with the belly-button approach (TUBA), and certain very cohesive silicone implants might require a larger incision to fit them in.
Your Anatomy: Everyoneโs breasts are different. The width of your areolas, the position of your crease, the amount of breast tissue and skin, and your overall chest shape all influence what incision will heal best. For example, if you have very small areolas, a periareolar incision might limit the surgeonโs visibility.
Priorities About Scarring: Some patients prioritize having the smallest scar on the breast itself and may opt for transaxillary or TUBA if possible. Others might prefer the safest, most precise approach (often inframammary) and are comfortable with the scar in the fold. Think about how you feel about a scar on the underside of the breast vs. around the nipple or under the arm.
Surgeonโs Experience and Recommendation: Surgeons develop preferences and skills. At Vitapera Clinic, our doctors will discuss why they might favor one incision over another based on years of training and experience. Weโll present the options we think will give you the best outcome given your body and goals.
Oncologic Considerations (for cancer surgery): If youโre having a mastectomy or related procedure, the main goal is removing all the cancer safely. Your oncology team will guide the incision pattern to achieve this, and a reconstructive surgeon will coordinate how to reshape the breast after. In this case, the medical need takes precedence, but we still strive for aesthetic placement of the incision.
Often, there are two or three reasonable approaches for a given case. We encourage open discussion: ask your surgeon why they recommend a particular incision. They should explain the reasoning (for example, โWe recommend an inframammary fold incision so we can precisely control the implant pocket for your desired large size.โ). Knowing the trade-offs will help you make a decision that fits your comfort level and goals.
Risks and Practical Considerations
Itโs important to have realistic expectations about scars and recovery with any breast surgery. Here are some practical notes to keep in mind:
Scar Healing: Initially, a new scar is red or pink and slightly raised. Over the first year or two, it will gradually fade and flatten. It wonโt disappear completely, but most scars become thin and pale, especially if well-cared for. Scars in the breast crease and around the areola usually become hard to see after a year. However, every person is differentโsome people tend to heal with thicker (hypertrophic) or wider scars. Good skincare (like gentle massage and avoiding sun exposure on the scar) helps it mature. At Vitapera Clinic, we give detailed wound-care instructions and can recommend silicone sheets or gels if needed to optimize healing.
Sensation Changes: As mentioned, incisions near the nipple or that involve significant tissue rearrangement can lead to numbness or altered sensation. Often this is temporary: nerves can grow back over months. Many patients notice some numbness around the areola or nipple for a while after surgery, but it often improves by 12โ18 months. In rare cases, some loss of feeling can be permanent. If preserved, nipple sensation can return in time, but if the nerves were cut, full sensation might not come back. This is one reason patients should discuss the risks of sensation change with their surgeon.
Breastfeeding: If you hope to breastfeed in the future, incision choice can matter. In general, inframammary, transaxillary, and TUBA incisions are less likely to affect the milk ducts than an incision right through the nipple area. The periareolar lift or augmentation, and lifts that rearrange tissue around the nipple, carry a higher chance of affecting milk supply. That doesnโt guarantee you wonโt breastfeed, but it does raise the risk of difficulty. If breastfeeding is a top priority for you, be sure to bring this up in your consultation so your surgeon can plan accordingly.
Revisions and Future Surgery: Sometimes patients want to upgrade implants or have a future revision. Some incisions are easier to use again. For example, the inframammary incision is often reused if the implant is changed years later. If you have a periareolar or armpit incision originally, and later you want to switch that route, the surgeon can usually re-cut in the same spot, but if you want to change approach, an inframammary one might be added later. Itโs not a huge problem, but worth noting. The main thing is to try to preserve options: for example, if scarring is minimal with one approach now, it might not look as neat if redone or extended later.
Complications: Any surgery has risks. Incisions can sometimes heal poorly if you smoke, have diabetes, or poor circulation. Infections, though relatively rare, can affect incisions. Some people develop raised or keloid scars. Our clinic screens patients for risk factors and provides close follow-up. If you have concerns (like a history of keloids or high BMI), discuss them with your surgeonโwe may take extra precautions or choose an incision that has a lower risk of wound problems.
Overall, most patients find that the small trade-offs (like a scar) are worth it for the final result theyโre seeking. Our goal is to minimize risks and make healing as smooth as possible, giving you clear guidance at every step.
Questions to Ask Your Surgeon
Finally, itโs crucial to remember that your surgeon is your guide in this journey. We encourage patients to have a list of questions prepared. Here are some key questions you might consider:
- Which incision do you recommend for my case, and why? Ask your surgeon to explain their reasoning. This gives you insight into the pros/cons for you specifically.
- How will the incision affect nipple sensation and breastfeeding? Even if your priority isnโt having children, itโs worth knowing what to expect in case circumstances change.
- Can I see photos of scars from each incision type (healed for 1+ years)? Actual before-and-after pictures can help you visualize the results. (Surgeons often have a portfolio.)
- Where exactly will my scars be, and how long are they? Make sure you understand the placement. You can ask your surgeon to draw on an example or show you on a model.
- If I want large implants or a certain amount of lift, will this incision allow that? Some incisions limit how large an implant can be placed or how much skin can be removed.
- What is your experience (complication and revision rate) with this incision type? Surgeons usually have good outcomes, but itโs fine to ask about their track record, especially if youโre considering a less common approach.
- What should I do to prepare for surgery and help my incision heal well? This might cover quitting smoking, vitamins, or special bras to wear after surgery.
- How should I care for my incision afterward? Learn about changing dressings, when to shower, when to avoid lifting, and when to follow up for suture removal or check-ups.
At Vitapera Clinic, our surgeons are happy to spend time answering these questions. We want you to feel fully informed and comfortable before moving forward.
Embracing the Process
Choosing to have breast surgery is a significant decision, and understanding incisions is just one piece of the puzzle. Remember that every approach involves an incision and subsequent scar โ itโs not a matter of getting surgery without scars, but rather of choosing scars in locations youโre most comfortable with. Our team will work closely with you to place incisions thoughtfully, perform the surgery skillfully, and support your healing journey afterward.
As you continue your research and planning, keep in mind: a well-informed patient is an empowered patient. Feel free to reach out to Vitapera Clinic for a consultation where we can discuss your unique anatomy, goals, and concerns in detail. Together, weโll determine the best incision approach to give you a safe surgery and the beautiful outcome youโre dreaming of.
