Incision Methods — Trans-Axillary, Inframammary, Periareolar Compared
The incision decision is one of the three biggest patient-facing choices in primary breast augmentation (alongside implant choice and placement plane). It determines where the surgical scar will sit, how the breast itself looks after a year, and to a smaller extent which surgical techniques are possible. This guide compares the three main incision approaches honestly — including what each gives up in exchange for what it offers.
Trans-axillary (armpit) — Umnagumo specialty
The trans-axillary approach places the incision in the natural skin fold of the armpit. The scar sits there — not on the breast itself. After 6–12 months, the line fades into the existing armpit fold and is typically hard to see without close inspection in most patients.
Umnagumo has run a dedicated trans-axillary system since 2005, and applies the approach to both primary and a substantial share of revision cases. The technique requires longer surgical training and more demanding endoscopic visualization in the pocket — it is not the fastest approach, but the breast is left without a visible scar.
Trade-offs: not every revision pocket can be approached through the armpit (some bottoming-out and capsular contracture revisions need direct inframammary access); patients with very high or very low natural pectoralis attachment may not be ideal candidates.
Inframammary (under-breast fold) — direct access
The inframammary fold approach places the incision in the natural crease where the breast meets the chest wall. The scar is short (typically 4–5 cm) and tucked into the crease — visible when the breast is lifted, hidden when standing or sitting normally.
This approach gives the most direct access to the pocket and is the standard choice in most Western practices. It is the easiest approach for revision cases that require direct lateral or inferior access (capsule correction, bottoming-out repair, autologous tissue reinforcement).
Trade-offs: a visible scar at the breast crease, even if usually well-hidden. In patients with no natural inframammary fold (very thin patients, certain reconstruction cases), the fold may need to be surgically created — and the scar then sits at the planned new fold.
Periareolar (around the areola) — concealed in the border
The periareolar incision runs along the lower border of the areola, where the pigmented skin transitions to the lighter chest skin. In many patients, the colour transition disguises the scar over the long term.
Access is direct, and the approach is commonly chosen when areolar reduction is being done at the same time (the same incision serves both purposes). It is also a reasonable choice when the patient already has a periareolar scar from a prior surgery.
Trade-offs: in lighter-skinned patients the scar can remain visible after the pigment transition does not fully disguise it. There is more theoretical risk of disrupting sensation in the nipple-areolar complex than the trans-axillary or inframammary approaches — small in modern practice, but real.
Trans-umbilical (TUBA) — limited modern use
The trans-umbilical (through the navel) approach places the incision in the belly button and dissects superiorly. It leaves no chest or armpit scar but limits implant choice to saline (which can be inserted deflated and filled in place). With cohesive silicone gel as the current standard, TUBA's role in mainstream practice has shrunk substantially.
Mentioned here for completeness; rarely the right choice in current Korean practice.
Choosing the right incision
The decision rests on three things:
- •Where you can accept a scar — armpit (axilla), breast crease (inframammary fold), or areola border.
- •Whether your revision history or anatomy requires direct lateral/inferior access — if so, inframammary is usually the answer.
- •Surgical fit — the surgeon's experience in the specific approach matters more than which approach is theoretically best. A reliably-executed inframammary case is better than an inexpertly-executed trans-axillary one.
The most common reason patients come to Umnagumo from outside Korea is the trans-axillary approach — the breast left without a visible scar. It is not the only good approach, and it is not the right answer for every case. But where the anatomy supports it and the patient wants a scar-free breast, the trans-axillary system is what we have built for the last 20 years.