The procedure for inserting breast implants varies somewhat by doctor, but there are a few main variations to the surgery.  Although it may seem simple, the planning and surgical decision-making for an augmentation is quite complex.  Every single patient and every breast is unique.  Even a patient's own two breasts are unique.  Therefore, it takes a considerable amount of experience to recognize subtle differences and understand how to approach a particular breast.


There are 3 commonly used incisions for augmentation of the breasts: Axillary (underarm), Periareolar (nipple), Inframammary (in the crease below the breast).

Axillary:  This incision can yield nice results, but there are some problems with it too.  When the scar is hidden, it is great.  However, when it is visible, it usually looks horrible.  It is also more technically challenging to dissect the implant pocket, and therefore there is a higher rate of implant malposition and inframammary fold problems.

Periareolar:  This is a foavrite approach for many surgeons.  The scar hides relatively well if placed exactly at the junction of the areolar darker skin and lighter surrounding breast skin.  It may lead to slightly increased rate of nipple sensation problems or future breast-feeding.  Also, recent evidence suggests a higher incidence of capsular contracture when this approach is used.

Inframammary Fold:  This is a great option for most instances.  The scar hides very well and is almost imperceptible at 1 year.  The problems with the periareolar approach are also avoided.


Over the muscle or below it?  Which is better?  As stated previously, each case is different, but there are some distinct advantages and disadvantages to both.

Over the Muscle:  There are two advantages to this placement: 1. The recovery is usually a bit easier as the muscle is not stretched and therefore not sore as in the submuscular placement. 2. You can obtain a rounder, more artificial shape, if that is your goal.

Under the Muscle:  Submuscular placement usually refers to a placement partially covered by the pectoralis muscle and partially covered by the breast gland.  This choice causes a week or two of chest muscle soreness (like after a good chest workout).  However, the advantages are great: better support and protection of the implant, more natural shape and feel, less capsular contracture.


General anesthesia, conscious sedation and local anesthesia are all possible.  Most surgeons prefer either general or deep sedation to keep the patient comfortable and unconscious during the breast augmentation procedure.


Most proficient breast surgeons can complete the entire procedure in 30-60 minutes for a standard augmentation.  Simultaneous lifting or other complexities will add more time to your surgery's length.