Breast Augmentation Approaches

A breast augmentation approach is the way that Dr. Durkin inserts your breast implants. There are a number of different breast augmentation approaches with regards to the incision that can be made. They all have advantages and disadvantages. With FDA approval of silicone breast implants, the use of each incision has changed because most women want silicone implants, which do offer a superior look and feel.

4 Breast Augmentation Approaches

There are 4 types of breast augmentation approaches:

  • Inframammary – This approach involves an incision in the crease between the chest and breast. This is the most common approach used for breast augmentation in the nation as it allows excellent control of the breast pocket with a very well hidden scar. I use this implant approach commonly in patients who have a well developed inframammary fold. As well, all shaped (aka tear-drop or anatomic) silicone breast implants are placed via an inframammary incision.


  • Periareolar – This breast augmentation approach makes an incision at the border of the nipple and the skin. This incision is best for women with pale skin and a “salmon” colored nipple. This incision is well hidden when placed at the appropriate level. However, this incision is visible to the patient regardless of how well it heals. As well, these incisions are difficult to manage if they do not heal as intended. Scars at this location can be very visible. We recommend avoidance of this incision unless other incisions are worse options.


  • Endoscopic-Assisted Transaxillary approach – I can place a saline or silicone prosthesis without any noticeable incision on the breast. With the endoscope, I have complete surgical control and can create any size pocket necessary. This is the most advanced and difficult technique in breast augmentation. I use it routinely when women want to avoid incisions on the breast, and when their anatomy is favorable for this approach.


  • Umbilical Approach (TUBA) – I do not use this breast augmentation approach. Having said that, it is a very acceptable approach to breast augmentation. The problem with it is that you can only use a saline implant. The overwhelming majority of my patients receive silicone implants because of its more natural feel, and because it offers less “rippling” along the sides. If you are interested in a saline augmentation, consider this approach. Otherwise, avoid it.

Silicone Implants

Silicone implants come prefilled. Because of this, the incision size can vary depending upon how large you want to be. At Ocean Drive Plastic Surgery, we use what is called a “Keller Funnel” during each augmentation case. This allows us to limit the incision to 3.5 centimeters to 4centimeters in size when placing smooth, round silicone implants. Hiding the incision beneath the breast obviates the different scar size, as does placing it in the armpit with an endoscope, but in every case, we strive to make the smallest incision possible. Shaped, or anatomic implants require a slightly larger incision for placement, and they are always placed via an inframammary approach.

Picking Implant Size

Implant Incisions

Breast augmentation approaches
Dr. Alan Durkin, Board Certified Plastic Surgeon, discusses different breast augmentation approaches to the placement of your breast implant.
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