Breast Fold for Faster Recovery vs Armpit to Hide the Scar:
Which Breast Augmentation Incision Suits You?

Breast fold incision when precise design is needed

The breast-fold incision is made along the crease under the breast, and surgery is performed while directly checking the space where the implant will go. Because the surgical field is seen directly, it is well suited to fine-tuning implant position, breast fold height and pocket size.

The advantages of the breast-fold incision are especially clear in the following cases.

When there is left–right breast asymmetry

Even before breast augmentation, the two breasts often differ in size, shape, nipple position and fold height. In fact, left–right differences in fold and nipple position are common before augmentation. Because the breast-fold incision lets the surgeon adjust the pocket and fold position while seeing both sides, it is a favorable approach for breasts that need fine asymmetry correction. For example, if one fold is higher or lower, implant position and fold height can be adjusted together to balance both breasts. The breast fold is an important anatomical landmark that determines lower-pole volume and overall breast shape, so setting it accurately matters.

When there is sagging or pseudoptosis

If the breast sags or has pseudoptosis, a design that considers the breast fold and the position of the lower tissue is more important than simply placing an implant. The breast-fold incision gives direct access to the lower breast and fold, which is an advantage when correcting this kind of breast. Especially for small, sagging breasts or when the relationship between nipple position and the fold must be fine-tuned, choosing the breast-fold incision makes it easier to plan surgery specifically. In augmentation, fold position directly affects implant position and the final breast shape, so preoperative design is important.

When the fold position must be fine-tuned

In breast augmentation, the breast fold is not just a skin crease but an important reference line that determines the lower breast contour and implant position. Because the breast-fold incision lets the surgeon see the needed position directly, it is favorable for keeping the existing fold or moving it to the desired position. Its advantages are greatest when the two folds differ in height or the lower space must be adjusted to the implant size. Because the surgical area is concentrated just below the breast, the needed areas can be reached directly, and recovery tends to be relatively fast.

Armpit incision when you want to hide the scar

The armpit incision is made along the armpit crease, and a tunnel is used to create the space for the implant inside the breast. Its biggest advantage is that it leaves no incision scar on the breast skin itself.

When sagging is minimal or mild

The armpit incision is most useful for augmentation focused on adding volume without major reshaping. Especially when the breast fold is well formed and there is almost no sagging, the implant can be placed through the armpit without creating an incision on the breast. Conversely, when sagging also needs correction or the fold position must change significantly, the breast-fold incision, which approaches the breast directly, is more favorable. Because the armpit approach is far from the breast, it is limited in directly adjusting breast tissue and lower structures.

When you do not want a scar directly on the breast

The clearest advantage of the armpit incision is that no incision scar forms on the breast itself. The incision lies in the natural armpit crease, so it can stay inconspicuous when your arms are down or in daily life. This is an important criterion for people who find a scar on the breast most burdensome.

When the breast fold is not well defined

If the breast fold is not very visible to begin with, approaching through the armpit rather than making an incision under the breast can be an advantage. Especially for small breasts without a distinct fold, augmentation without leaving an incision scar on the breast is a representative advantage of the armpit incision. However, because the armpit incision approaches from a distance, a longer dissection path is needed. So early after surgery, you may feel pulling when moving your arms widely, or stiffness between the armpit and breast.

The two incisions compared at a glance

The breast-fold incision gives direct access to the surgical area, so it is strong in design and position control; the armpit incision is strong in hiding the scar, leaving none on the breast skin. Both are established clinical approaches, and the result is determined not only by incision site but also by implant choice, pocket plane, and the condition of the skin and breast tissue.

In a study comparing 364 patients with the same implant, complications were 1.8% with the breast-fold incision and 2.7% with the endoscopic armpit incision, with no significant difference.^[1]

Related readingWhen scars fade after surgery is covered in "When will breast augmentation scars fade?" (Korean).

How do I choose the right incision?

Choosing an incision only by "which scar shows less" is not accurate.

If you have breast asymmetry → breast fold incision

If breast size, nipple position or fold height differ, the breast-fold incision is favorable because the differences can be checked and adjusted directly during surgery. When pre-existing asymmetry must be corrected, it is important to adjust the fold and implant position together.

If you have sagging or pseudoptosis → breast fold incision

For sagging breasts, placing an implant is not enough; the shape of the lower breast and the fold position must also be adjusted. When lower-pole design matters, the breast-fold incision is favorable.

If a scar on the breast is your biggest concern → armpit incision

If you don't want incision marks on the breast fold or areola, the armpit incision has the most direct advantage. Because it uses the natural armpit crease, no scar forms on the aesthetic center of the breast.

If the breast fold is barely visible → armpit incision

If the breast fold is not distinct and sagging is minimal, approaching through the armpit without creating a scar on the breast can be an advantage. It is especially useful for small breasts when surgery focuses on adding volume.

Related readingScar differences by areolar incision method are covered in "Areola reduction: how do scars and recovery differ by incision method?" (Korean).

What matters as much as the incision site?

When deciding the incision in breast augmentation, we do not look at the incision site alone but also check implant size and shape, placement plane, breast tissue thickness, the breast fold, nipple position and left–right asymmetry. Because most breasts are not perfectly symmetric before surgery, it is important to identify the differences beforehand and reflect them in the plan. Fold position and symmetry are key factors in the final breast shape, so they must be measured and designed accurately. Also, while the armpit incision has the advantage of no breast scar, its longer access path can widen the surgical area, and an additional incision may be needed if corrective surgery is later required. Conversely, the breast-fold incision allows direct access but means accepting a scar under the breast. So in consultation, rather than asking "which incision is better?", it is best to first decide whether your main goal is asymmetry correction, sagging improvement, fold design or a minimal scar, and then choose the incision accordingly.

In a meta-analysis of 7 studies comparing capsular contracture by incision site, the periareolar incision had more capsular contracture than the breast-fold incision, and there was no difference from the armpit incision.^[2]

Breast augmentation incisions: common myths and facts