Expert Doctor

Breast Augmentation Procedures


Periareolar Incision vs. Inframammary Incision

In California, the most popular way of inserting a breast implant is through what’s called a periareolar incision, which is also known by the nick name “nipple incision”.  The incision is not actually on the nipple, but instead along the outer edge of the areola. However, periareolar incisions do not deliver the implant in the most expeditious and least destructive way possible.  To understand why, imagine when a woman lies on her back for surgery with her breasts flattened along the chest, the thickest part of her breast tissue is at the nipple area.  A periareolar incision forces the surgeon to create a tunnel through her entire mammary gland down to the pectoralis muscle where another incision is made in the muscle to access the space under the muscle. The surgeon still has to then cut the muscle along its connection to ribs as well.  That’s a lot of unnecessary cutting of breast and muscle. In stark contrast, an inframammary incision allows the surgeon to traverse very little tissue just below the breast to enter the space below the muscle, and simultaneously releasing the muscle from its rib attachments

Although the periareolar incision is the most popular technique in Southern California, in the rest of the US and around the world, most doctors perform breast augmentation through an inframammary incision.  Scientific studies have shown us that the incision with the lowest complication rate is an inframammary incision.  Patients are going to recover faster and have a lower risk of complications. 

The way I perform breast augmentation is through an inframammary incision, under the pectoralis major muscle, with properly sized implants. Roughly one third of my patients are capable of driving to their postoperative appointment the following day. Most people are driving a motor vehicle and are back to all their usual activities within 2-3 days. None of my patients are prescribed narcotic medications for pain. They only need ibuprofen for mild stiffness and discomfort. 



Transumbilical vs Transaxillary

There are two scarless breast augmentation procedures that involve remote incisions. A transumbilical operation involves a remote incision in the bellybutton while transaxillary breast augmentation utilizes a remote incision in the armpit. These two surgeries are different from each other in that transumbilical surgery can only be performed with saline implants whereas transaxillary surgery can utilize either saline or silicone.

Another difference is that transumbilical breast augmentation can only be done blindly. The surgeon has to blindly perform maneuvers with a hockey stick-shaped metallic rod that forms a pocket either over or below the muscle. During transaxillary surgery however, the doctor has the opportunity of fully utilizing an endoscope, which gives the surgeon the ability to see the surgical field directly and use more gentle techniques. During transumbilical surgery, the surgeon is limited to performing blunt dissection which unnecessarily traumatizes tissue. Because of this I find the transaxillary procedure superior to trans-umbilical.



When comparing the different types of surgical techniques, transumbilical surgery carries the highest risk of complications and a longer recovery when compared to either transaxillary or inframammary surgeries.  Additionally, the inframammary technique offers the least risk and quickest recovery by far. 


Written by Cosmetic Town Editorial Team based on an exclusive interview provided by Dr. Gerald Minniti in Beverly Hills, CA.