Which incision approach is most common?

Inframammary fold (IMF) incision is the most widely used worldwide for primary breast augmentation. It offers direct visualization of the pocket, controlled hemostasis, and the option to use any implant size or shape. The scar sits in the natural breast crease.

What is the advantage of transaxillary incision?

The transaxillary (underarm) approach avoids any scar on the breast itself. Modern transaxillary surgery is typically performed with endoscopic assistance for direct visualization of the pocket. It is technically more demanding than IMF; not all implant sizes or shapes are feasible. Popular in Asia, including Korea.

What is the periareolar approach used for?

The periareolar incision (along the lower border of the areola) is suitable for combined procedures such as augmentation with nipple/areola correction. It can affect nipple sensation in some patients and historically has higher capsular contracture rates than IMF in some studies (likely due to contact with breast ducts and biofilm).

Is the transumbilical incision still used?

Transumbilical breast augmentation (TUBA) places the implant via an umbilicus incision. It is rarely performed and is limited to saline-only implants. It is not commonly recommended for silicone gel implants and is not a routine option at most modern breast-focused clinics.

Which incision has the lowest scar visibility?

Scar visibility depends on patient skin type, scar care, and incision tension — not only on location. The transaxillary approach avoids any breast-area scar. The IMF approach hides the scar in the natural breast crease (typically not visible standing facing forward). Periareolar scars sit on the areolar border. Individual scar appearance varies.

Incision Options

Breast Augmentation Incision Options — Inframammary, Transaxillary, Periareolar, Transumbilical

UNE Plastic Surgery · Dr. Kim Uigeon, board-certified plastic surgeon · Published 2026-05-15

Four incision approaches are used in breast augmentation. The choice affects scar location, surgical visualization, implant options, and certain complication patterns. This article compares the four — inframammary, transaxillary, periareolar, and transumbilical — across the criteria patients usually weigh.

1. Quick Comparison

Incision	Scar Location	Visualization	Implant Flexibility	Notes
Inframammary (IMF)	Breast crease	Direct, excellent	All sizes / shapes	Most widely used worldwide.
Transaxillary	Underarm	Endoscopic-assisted	Some size / shape limits	No scar on breast; technically demanding.
Periareolar	Lower areola border	Direct	Most sizes	Combined with nipple/areola work; some sensory and contracture considerations.
Transumbilical (TUBA)	Umbilicus	Indirect	Saline only	Rarely performed; not standard for silicone gel.

2. Inframammary (IMF)

Advantages

Direct visualization of the pocket — precise dissection and hemostasis.
Compatible with all implant sizes, shapes, and shell types.
Lower rate of contact with breast ducts; lower contracture rate than periareolar in some studies.
Convenient for future revision surgery.
Scar sits in the natural breast crease — typically not visible standing.

Considerations

A small (typically 4-5 cm) scar in the inframammary fold.
For thin patients with high-riding nipples, IMF position must be planned carefully to maintain natural proportions.

3. Transaxillary

Advantages

No incision on the breast itself.
Modern endoscopic-assisted technique provides good visualization.
Popular in Asia, including Korea, where preference for scar-free breast surface is common.

Considerations

Technically more demanding; requires surgeon experience with endoscopic technique.
Pocket control near the IMF is indirect; precise dissection requires technical skill.
Some implant sizes (very large) and shapes (some anatomical implants) may not be feasible.
Future revision surgery often uses an IMF approach rather than re-entering through the axilla.
Scar location is the axilla — visible when arms are raised; appearance varies with patient skin and scar care.

4. Periareolar

Advantages

Scar follows the natural pigment border of the areola — often subtle in patients with strong color contrast.
Allows simultaneous nipple/areola correction (areolar reduction, inverted nipple correction).
Direct visualization of the inferior pole pocket.

Considerations

Some patients report changes in nipple sensation post-op; long-term sensory recovery varies.
Some studies suggest higher capsular contracture rates than IMF — possibly due to contact with breast ducts and biofilm exposure during dissection.
Future breastfeeding may be affected in some cases.
Less suitable for patients with small areolae or pale areolar pigmentation.

5. Transumbilical (TUBA)

Rarely performed in contemporary practice.
Limited to saline-fill implants — not used for silicone gel implants.
Indirect tunnel dissection from umbilicus to chest with limited visualization.
Not a routine option at most modern breast-focused clinics; included here for completeness.

6. Choosing the Right Approach

The choice depends on multiple factors:

Body type and IMF position — defined IMF favors IMF approach; subtle IMF may favor transaxillary in selected cases.
Implant size and shape — larger or shaped implants favor IMF; smaller round implants are compatible with transaxillary.
Areola size and pigmentation — well-defined areolar pigmentation favors periareolar if other criteria align.
Patient preferences — bridal, beach, or arms-raised activities; visibility tolerance.
Future revision planning — revisions are often easier through IMF.
Combined procedures — areolar reduction or inverted nipple correction may favor periareolar.

7. Scar Care — Common to All Approaches

Silicone sheets or gels (start 2-3 weeks post-op, after wound sealing).
Sun protection on scar for 6-12 months.
Avoid mechanical tension on the incision during early healing.
Patients with darker skin types should monitor for hypertrophic or keloid scarring; surgeon may recommend additional therapy.

Medical disclaimer. Results, recovery time, pain, swelling, and scar appearance vary depending on each patient's anatomy, tissue condition, surgical plan, and healing process. Incision choice should be made after in-person assessment by a board-certified plastic surgeon.

— Dr. Kim Uigeon (Board-certified plastic surgeon, Republic of Korea · UNE Plastic Surgery)