Different Types Of Breast Augmentation Incisions

Breast augmentation remains one of the most popular cosmetic surgery procedures in the UK, with numbers increasing year on year. One of the most important — and often overlooked — decisions in the whole process is the type of incision your surgeon uses to place the implant, since this determines where any resulting scar sits, how it heals, and what your options look like if you ever need revision surgery. This guide covers the four incision types used in breast augmentation in detail, their benefits and drawbacks, how to think through which suits your circumstances, and what recovery and scar healing genuinely look like.

What Are the Four Types of Breast Augmentation Incisions?

There are four surgical approaches for inserting breast implants:

• Inframammary — a fold incision located underneath the breast
• Periareolar — an incision encircling the lower border of the areola
• Transaxillary — the incision is located in the armpit
• Transumbilical — inserted via the belly button, or umbilicus

There’s no single “best” incision for every patient — the right choice depends on your anatomy, the implant type and size you’re considering, whether you’re also having a breast lift, and whether you’re planning to breastfeed in future. Your surgeon will discuss the most appropriate option for your goals and anatomy at consultation.

Common Myths About Breast Augmentation Incisions

There’s a fair amount of confusion about incisions circulating online. A few of the most common myths, and the facts:

“A hidden incision means no risk.” Myth. Incisions like transaxillary or transumbilical hide scarring well, but they trade off surgical precision and revision flexibility — “hidden” isn’t the same as “lowest risk overall.”

“The incision determines your final breast size and shape.” Myth. Incision choice affects access and scarring, not the aesthetic outcome itself — that’s determined by implant size, profile, and placement (over or under the muscle), which are separate decisions made alongside incision choice.

“All incisions can be reused for revision surgery.” Myth. Only the inframammary incision is reliably reusable for future revision — transaxillary and transumbilical incisions generally can’t be, meaning a fresh incision is needed if revision is ever required.

“Areola size doesn’t matter for incision choice.” Myth. It’s a genuine, practical limiting factor for the periareolar approach specifically, since silicone implants need a minimum incision length that not every areola can comfortably accommodate.

Inframammary Incision

The inframammary incision is made within the crease where the underside of the breast meets the chest wall, and it’s the most commonly used incision in breast augmentation surgery. Many surgeons prefer it because it’s located away from the nipple and areola, which minimises the risk of bacterial contamination from that area — bacteria that, while not dangerous in themselves, may contribute to a higher risk of capsular contracture, a hardening of the scar tissue capsule that can distort implant shape and require revision surgery.

This incision gives the surgeon direct visualisation of the pectoralis muscle, allowing precise control over whether the implant sits above or below it. It also results in the most accurate creation of a breast pocket for optimal implant positioning and symmetry. If revision surgery is ever needed, the inframammary incision is almost always the one used regardless of your original approach — so choosing it for your first procedure means no additional scarring if a later revision is required. It also doesn’t affect nipple sensitivity or future breastfeeding ability, since it’s placed beneath the breast itself, away from the milk ducts.

The main drawback is that it does leave a visible scar, most noticeable when lying flat on your back, though it typically fades and flattens considerably with proper aftercare over the following months.

Periareolar Incision

The periareolar incision is placed around the lower border of the areola, at the transition where the pigmented skin meets the surrounding breast skin — a natural colour change that can help disguise any resulting scar.

Areola size varies significantly between women, and this genuinely affects incision choice: silicone implants require a minimum incision length of around 4–5cm to be inserted safely, so women with smaller areolas may not have enough circumference to accommodate this comfortably. In these cases, the inframammary or transaxillary approach is usually more appropriate. Saline implants (rarely used in the UK today) can be inserted through a shorter incision, since they’re placed in a deflated state and inflated once positioned.

The periareolar approach is associated with a somewhat higher risk of capsular contracture than the inframammary route, and because the incision passes directly through breast tissue near the nipple, it carries a greater risk of affecting nipple sensitivity and can interfere with breastfeeding, since the incision may transect the milk ducts. This is worth discussing carefully at consultation if future breastfeeding is a priority for you.

Transaxillary Incision

The transaxillary incision is positioned in the armpit, with the surgeon creating a tunnel from the underarm to the breast pocket, typically using an endoscope to guide precise placement — the incision itself is usually around 5cm.

The main appeal is that it avoids any visible scarring on or around the breast itself, with the incision hidden in the armpit — though it can be more noticeable in certain clothing, such as swimwear, and some women notice a degree of reduced sensitivity in the area. The trade-off is reduced visibility of the breast tissue during surgery compared with a direct approach, which can make precise implant positioning more technically demanding, and there’s a correspondingly higher associated risk of implant malposition. If revision surgery is ever needed, the transaxillary incision generally can’t be reused — revision is carried out via a fresh inframammary incision instead.

Transumbilical Incision

The transumbilical approach — sometimes called TUBA — involves an incision at the belly button, with the surgeon creating a subcutaneous tunnel from there up to the breast pocket. The appeal of leaving no marks anywhere on or near the breast is understandable, but this technique carries meaningful drawbacks that lead most reputable UK surgeons, including our own, not to offer it.

Implant placement via this route is considerably less precise, carrying a higher risk of an uneven or unsatisfactory result and a significantly increased risk of implant malposition. It’s only really compatible with saline implants — which are very rarely used in UK augmentation today — since silicone implants generally can’t be safely inserted through a tunnel this long. If revision surgery is needed, which is more common with this approach, the belly button incision can’t be reused; a fresh incision on or around the breast is required regardless. We don’t recommend this incision because of its comparatively high risk of complications.

Comparing the Four Incision Types

At a glance: the inframammary incision offers the best balance of precision, breastfeeding safety, and revision compatibility, at the cost of a scar directly on the breast. The periareolar incision hides scarring well but carries higher risk to nipple sensation and breastfeeding. The transaxillary incision avoids any breast scarring but trades off surgical precision and revision flexibility. The transumbilical incision, while appealing for leaving no marks near the breast at all, carries meaningfully higher risk across the board and isn’t something we recommend or routinely offer.

Choosing the Ideal Incision for Your Circumstances

Deciding on the best incision for your breast augmentation is a personalised process that should always involve a thorough consultation with a qualified plastic surgeon, factoring in your breast shape and size, overall health, and the specific implant type you’re considering.

If you’re planning to have children in the near future, it’s worth prioritising an incision type carrying a lower risk of affecting breastfeeding — the inframammary approach is generally the safer choice here. If avoiding any visible scar on the breast itself is your top priority, the transaxillary approach may be more fitting, accepting the trade-offs in precision and revision flexibility that come with it. If you want maximum precision in implant placement and the most predictable long-term result, the inframammary incision is usually the strongest option. If you’d rather camouflage scarring near the areola specifically, and your anatomy allows for it, the periareolar incision may be appealing.

Long-Term Considerations and Revision Surgery

Your body changes over time, so how your implants look several years after surgery may differ meaningfully from how they appeared initially. Since implants aren’t designed to last a lifetime, it’s realistic to expect that revision surgery may be needed at some point in the future — and the incision you choose initially genuinely affects how straightforward that future procedure will be.

If you have a transaxillary or transumbilical incision the first time around, these entry points generally can’t be reused for future corrections or replacements — a fresh inframammary incision would be needed regardless. This is one of the most practical reasons many surgeons default to recommending the inframammary approach even for a first-time augmentation: it keeps your options open and avoids accumulating additional scars over multiple procedures throughout your lifetime.

The Recovery Process and Scar Healing

Healing after breast augmentation takes time and proper aftercare, regardless of which incision you have. In the first few days you’ll typically notice swelling, bruising, and some discomfort in the chest area, managed with prescribed pain relief. Incision care is one of the most important parts of a smooth recovery — you’ll be given specific instructions on cleaning the area and, in many cases, a recommendation to use silicone gel or sheeting once the incision has fully closed, which genuinely helps flatten and fade the scar over the following months.

Most women can gradually return to normal daily activities within a few weeks, though strenuous exercise is typically restricted for around six weeks. Scars generally continue to soften and fade for up to a year after surgery — an incision that looks quite pink and raised at six weeks often looks dramatically different, flatter and paler, by the twelve-month mark.

Which Incision Does Centre for Surgery Use?

At Centre for Surgery, our surgeons almost exclusively use the inframammary fold incision for breast augmentation, combined with a specialist breast funnel for a “no-touch” insertion technique — reducing the implant’s contact with skin during placement and supporting precise, symmetrical positioning above or below the muscle. This reflects our surgeons’ clinical judgement that the inframammary approach offers the best overall balance of precision, safety, breastfeeding compatibility, and future revision flexibility for the great majority of patients.

Frequently Asked Questions

Considering Breast Augmentation? Book a Consultation

If you’re considering breast augmentation in London, we’d recommend discussing incision options in detail with your surgeon at consultation, alongside implant type, size, and placement. Breast augmentation at Centre for Surgery is performed by GMC-registered plastic surgeons, at our CQC-regulated Baker Street facility, under TIVA (Total Intravenous Anaesthesia) as a day case.

To book a consultation, call 020 7993 4849 and speak to one of our patient coordinators, or complete the contact form below.

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