Armpit, fold or areola: choosing the incision honestly
There is no best incision — there is the best incision for your anatomy, your goals and your tolerance for where a scar lives. Here are the three, compared on the things that actually differ.
- Inframammary (fold): the most direct pocket control and the standard for revisions; scar hidden in the fold, visible lying down or topless.
- Transaxillary (armpit): no scar on the breast; endoscopic pocket control; scar in the armpit, visible with arms raised; practical size limit for silicone.
- Periareolar: scar at the areola's edge; good for mild lifts; passes through breast tissue and ducts, with more nipple-sensation and breastfeeding considerations.
- Nipple nerves: best preserved by the armpit and fold routes.
- Revisions: almost always through the fold, whichever route was used first.
| Inframammary (fold) | Transaxillary (armpit) | Periareolar | |
|---|---|---|---|
| Scar location | In the breast fold | Armpit crease | Edge of the areola |
| Visible when | Lying down, topless, some bikinis | Arms raised | Topless; blends with areola border |
| Pocket control | Direct, most precise | Precise with endoscope | Direct but through gland |
| Implant size | Any | Saline any; silicone up to a practical limit | Limited by areola size |
| Nipple sensation / ducts | Preserved | Preserved | Higher consideration — passes through tissue |
| Lift possible | Minor adjustment only | No | Mild lift (crescent/periareolar) |
| Revision access | Best | Poor — revisions via fold | Fair |
| Ideal for | Most patients; larger implants; revisions | No breast scar; small areolas; little fold | Mild droop; large areolas |
Inframammary — the reference standard
Direct vision of the pocket, any implant size, the easiest revision access, and a scar in the fold that most bras and bikinis cover. Its honest downside is that the scar lives on the breast: visible lying down, topless, or in a small breast with little fold to hide it. For most patients and all revisions it remains the default — and Dr. Erdal says so even on this site.
Transaxillary — the no-breast-scar route
Everything on this site: no scar on the breast, endoscopic pocket precision, preserved nipple nerves, and the trade of an armpit scar visible with arms raised, a silicone size ceiling, and revisions that need the fold anyway. Right for patients who weigh those facts and still want the breast untouched. The complete guide covers it.
Periareolar — the lift-adjacent route
An incision at the areola's edge blends well in patients with a defined, larger areola and allows a mild lift at the same time. It passes through breast tissue and ducts, with more consideration for nipple sensation, breastfeeding and bacterial exposure of the implant. Good for specific anatomy; not a default.
Deciding: droop → fold or periareolar (with a lift); first augmentation, no droop, no breast scar wanted → armpit; large silicone implants, revisions, thin tissue needing edge control → fold. The photos you send settle most of it before the consultation.
Questions patients ask
It depends where you look. The armpit route leaves no scar on the breast but a visible line with arms raised; the fold scar is hidden in the crease under the breast but visible lying down; the periareolar scar blends with the areola border in the right patient.
Evidence suggests the fold and armpit routes, which avoid passing through breast ducts, carry lower contamination-related risk than the periareolar route. Technique — funnel insertion, pocket irrigation, minimal handling — matters more than the route.
Yes, until the day before surgery. The marking is done with you standing, and the plan is confirmed then.
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