When breast implant revision is needed, one of the first decisions is which incision approach to use. This decision is influenced by the type of revision required, the location of your original incision, and the complexity of the correction.
There is no single best incision for all revision scenarios. What matters is matching the approach to the specific problem. Here is an honest comparison of the three primary options.
Inframammary Fold (Under the Breast)
The inframammary fold incision is placed in the crease where the breast meets the chest wall. It is the most commonly used incision for revision surgery across all plastic surgery practices.
Advantages for Revision
- Provides the most direct access to the implant pocket and capsule.
- Allows complete capsulectomy, including en bloc removal for severe contracture.
- Accommodates all types and sizes of replacement implants.
- Enables simultaneous pocket modification, including plane changes and reinforcement with acellular dermal matrix.
- Most surgeons are highly experienced with this approach.
Disadvantages
- Creates a scar on the breast (typically 4–5cm in the crease).
- For women whose original augmentation was through a different incision, this adds a new scar in a new location.
- The scar, while usually well-concealed by the breast fold, may be visible in certain positions or clothing.
Best For
Complex revisions requiring extensive capsulectomy, significant pocket restructuring, concurrent mastopexy, or cases where the broadest possible surgical access is needed.
Periareolar (Around the Nipple)
The periareolar incision follows the border between the areola and the surrounding breast skin.
Advantages for Revision
- Provides reasonably direct access to the pocket.
- Scar is camouflaged by the color transition at the areolar border.
- Suitable for implant exchange and moderate capsule work.
Disadvantages
- Cuts through breast tissue, with potential effects on nipple sensation and breastfeeding capability.
- Limited access for large implants or extensive capsulectomy.
- Scar quality is variable — some patients heal with visible scarring at the areolar border.
- Risk of bacterial contamination from breast ducts during implant placement.
Best For
Patients whose original augmentation used a periareolar incision and who need straightforward exchange or moderate revision work.
Transaxillary (Through the Armpit)
The transaxillary incision is placed in the natural crease of the armpit, away from the breast entirely.
Advantages for Revision
- No scar on the breast — revision uses the same incision as the primary augmentation.
- Avoids cutting breast tissue entirely.
- With endoscopic visualization, provides camera-guided access for capsulotomy, capsulorrhaphy, and implant exchange.
- Preserves nipple sensation and breastfeeding capability.
- Typically faster recovery than open revision through the breast.
Disadvantages
- Requires endoscopic training that most plastic surgeons do not have.
- Not suitable for en bloc capsulectomy.
- Not suitable when concurrent mastopexy is needed.
- Limited availability — very few surgeons offer endoscopic revision through the armpit.
Best For
Patients whose primary augmentation was transaxillary and who need implant exchange, capsulotomy for Grade II–IV contracture, capsulorrhaphy for malposition, or implant rupture replacement. Ideal for women who specifically want to preserve their scar-free breast appearance.
How to Decide
The right incision for your revision depends on the clinical problem, not on preference alone. A surgeon who offers all three approaches can evaluate your specific situation and recommend the one most likely to achieve a lasting result with the least cost to your aesthetic outcome.
If you are being told that a breast incision is required for your revision, and you would prefer to explore the armpit approach, seek evaluation from a surgeon who actually performs endoscopic revision. A surgeon who does not offer the technique cannot objectively assess whether it would work for your case.
Conversely, if a surgeon tells you that every revision can be done through the armpit, be cautious. Intellectual honesty about limitations is a sign of good surgical judgment. The best approach is the one that matches the technique to the problem.