Breast surgery without visible scars: techniques for a more discreet augmentation

Why do scars form in breast augmentation surgery?

Every operation that involves an incision in the skin leaves a scar. The place where that incision is made, its size, the suturing technique used and the body’s own healing capacity all influence the final result.

In a breast augmentation the surgeon needs to create a way in to place the breast implant inside the pocket made in the tissue. That incision can be made in different strategic areas of the body, depending on the type of implant, the plane it goes in and the patient’s anatomy.

Surgical routes for hiding the scars

There are three main routes in for placing a breast implant. Each has specific advantages in terms of visibility, surgical control and how well it suits the clinical case.

1. Incision in the inframammary fold

This approach involves making a small incision in the natural crease formed beneath the breast, where the breast meets the chest. It is the most widely used technique worldwide.

Advantages:

• The scar is hidden in the natural breast crease, invisible from the front.
• It allows precise surgical control while the implant is being placed.
• It works with every type of implant and every plane.
• It reduces the risk of disturbing the mammary gland.

Points to bear in mind:

• It requires the inframammary fold to be well defined.
• It is not the ideal option if you want to avoid any scar at all on the chest, although with time it becomes almost imperceptible.

2. Periareolar incision (areolar approach)

Here the incision is made at the lower edge of the areola, in the transition between the paler skin and the pigmented skin. That contrast makes it possible to disguise the scar very effectively.

Advantages:

• A barely visible scar, camouflaged at the border of the areola.
• It gives central, symmetrical access to both breasts.
• It can be used at the same time to reduce the size of the areola if necessary.

Points to bear in mind:

• It is not indicated with small areolas or where there is a high risk of loss of sensation.
• It may slightly disturb the milk ducts, so it is assessed with particular care in women planning to breastfeed.

3. Armpit incision

The transaxillary route involves placing the implant through an incision in the armpit, away from the breast. It is one of the techniques most often asked for by women who want a result with no visible scars on the chest.

Advantages:

• The scar sits in a place away from the breast and is hidden in the natural crease of the armpit.
• There is no scar on the breast or in the inframammary fold.

Points to bear in mind:

• It does not allow as much freedom to adjust the position of the implant as the other approaches.
• Its use is limited to certain types of implant and planes (saline implants).

Which technique gives the most invisible scar?

There is no single technique that works for every case. The choice of route depends on several factors:

• The size and shape of the breasts.
• The size of the areola.
• The type of implant to be used.
• The patient’s aesthetic wishes.
• The surgeon’s experience with each technique.
• The history of healing and the quality of the skin.

In many cases the inframammary incision offers the best balance between surgical precision and aesthetic discretion, since it allows excellent control over the procedure and leaves a scar that is usually completely hidden.

In patients with well-defined, pigmented areolas, the areolar approach also gives very good aesthetic results. The armpit route, for its part, is ideal when the absolute priority is to have no scar at all on the breast, provided the necessary anatomical and technical conditions are met.

The scar is not the only criterion: what changes according to the route in

Choosing the route in solely by where the mark ends up leaves out an important fact: the incision also influences the risk of capsular contracture, which is the complication that most often means a breast augmentation has to be revised.

A meta-analysis bringing together seven comparative studies found that the periareolar route — the one around the areola, usually presented as “the best disguised” — was associated with almost twice as much capsular contracture as the other two routes combined: OR 1.83 (95% CI 1.06–3.15; p = 0.03). Against the inframammary fold specifically the difference held (OR 1.91; 95% CI 1.06–3.43; p = 0.03), while against the armpit route there was no significant difference (OR 0.94; p = 0.79). Five of the seven studies pointed the same way.

A far larger registry points in the same direction. In the follow-up of 17,656 patients with anatomical cohesive-gel implants, with a contracture rate of 2.3 to 4.1%, the risk factors identified in primary augmentation patients were subglandular placement, the periareolar incision and the age of the implant.

The most widely accepted explanation is that, in crossing the gland, the pocket comes into contact with the flora of the milk ducts, and that bacterial load favours the formation of a thick capsule. None of this makes the periareolar route forbidden — there are breasts and situations in which it is still the best option — but it does force one thing to be said plainly: the most discreet incision is not always the one with the lowest risk, and that decision deserves to be taken in full knowledge of it.

Can the scar be avoided altogether?

There is always a scar, but it can be made practically imperceptible through:

• Small incisions (usually 3 to 4 cm).
• Multi-layered suturing techniques with absorbable thread.
• The use of silicone dressings, sheets or topical treatments after surgery.
• Proper sun protection during the first few months.
• Dermatological follow-up if a tendency to keloid or hypertrophic scars is detected.

At our clinic we attend to every one of these points to ensure the best possible healing. We also teach each patient how to look after her scar from day one to get the most out of how it develops.

Does the type of implant affect the choice of route?

Yes. Some implants, such as anatomical ones or those with high projection, need greater precision in placement, so the surgeon may prefer the inframammary or areolar route.

For round implants of moderate size, on the other hand, all three routes can be considered viable provided the necessary technical conditions are met.

The plane of placement (subglandular, subpectoral or dual plane) and the type of breast tissue available also come into it.

Breast surgery without clearly visible scars is a reality thanks to advanced surgical approaches that allow implants to be placed precisely and safely while keeping marks on the skin to a minimum.

The decision about where the incision goes has to be taken individually, weighing up the patient’s aesthetic wishes, her anatomy and the surgical team’s experience.

At the Instituto de Cirugía Plástica del Mediterráneo, in Valencia, we analyse each case in detail to offer the most discreet, safe and effective option, always giving priority to the balance between aesthetic beauty and medical rigour. If you are considering a breast augmentation and want to avoid visible scars, we will be glad to see you for a first individual consultation.