Breast Implants: Placement and Incision Sites

The breast consists of milk ducts and glands, surrounded by fatty tissue that provides its shape and soft feel. Skin elasticity also contributes to breast shape. Factors such as pregnancy (when milk glands are temporarily enlarged) and the inevitable effects of gravity as you age combine to stretch the skin, causing the breast to droop or sag.

The breast implant can be placed either partially under the pectoralis major muscle (submuscular) or on top of the muscle and under the breast glands (subglandular) depending on the thickness of your breast tissue and its ability to adequately cover the breast implant. You should discuss with your surgeon the pros and cons of the breast implant placement selected for you.

The submuscular placement may make surgery last longer, may make recovery longer, may be more painful, and may make it more difficult to have some reoperation procedures than the subglandular placement. The possible benefits of this placement are that it may result in less palpable implants, less capsular contracture, and easier imaging of the breast with mammography. The subglandular placement may make surgery and recovery shorter, may be less painful, and may be easier to access for reoperation than the submuscular placement. However, this placement may result in more palpable implants, more capsular contracture, and more difficult imaging of the breast with mammography.

Incision Sites

To permit the smallest possible incision, the breast implant is typically inserted empty, and then filled with saline. You should discuss with your plastic surgeon, the pros and cons for the incision site specifically recommended for you. There are three common incision sites: under the arm (axillary), around the nipple (periareolar), or within the breast fold (inframammary).
If the incision is made under the arm, the surgeon may use a probe fitted with a miniature camera, along with minimally invasive (very small) instruments, to create a “pocket” for the breast implant.

Periareolar

This incision is most concealed, but is associated with a higher likelihood of inability to successfully breast feed, as compared to the other incision sites.

Inframammary

This incision is less concealed than periareolar and associated with less difficulty than the periareolar incision site when breast feeding.

Axillary

This incision is less concealed than periareolar and associated with less difficulty than the periareolar incision site when breast feeding.

Umbilical/endoscopic

This incision site has not been studied and is not recommended.