When people first begin researching breast augmentation, most of the discussion tends to focus on implant size, projection, and implant brands, such as Motiva or Mentor. However, one aspect that surprisingly remains a difficult decision right up until the final stages is the choice of incision site.  
  
Many patients are surprised to learn that the most commonly used breast augmentation incision worldwide is the inframammary incision (under-breast incision), which is placed in the natural fold underneath the breast. Because of this, we are occasionally asked why some surgeons and patients still choose the transaxillary incision (armpit incision) instead.  
  
The biggest reason is simply personal preference regarding scar placement. Although scars from an under-breast incision are often very well hidden once healed, some patients prefer not to have any scar on the breast itself. This is especially true for those who frequently wear bikinis, crop tops, or other clothing that exposes the lower portion of the breast. For these patients, hiding the scar within the natural folds of the armpit can feel like a more natural and aesthetically pleasing option.  
  
There is also a common misconception that implant size is limited when using an armpit incision. Since the armpit is located farther away from the breast than an under-breast incision, many patients assume that only smaller implants can be inserted using this approach. In reality, modern surgical techniques and implant technology allow surgeons to place a wide range of implant sizes through an armpit incision.  
  
The attached patient case is a good example of this in practice. The patient underwent breast augmentation using 360cc Motiva implants through an armpit incision. Interestingly, her main concern was not the implant size itself. During consultation, she explained that she regularly wears bikinis and fitted swimwear and preferred avoiding a scar on the breast whenever possible. For that reason, she felt that the armpit approach aligned better with her personal preferences.  
  
If even larger implants over 360cc can be inserted through an armpit incision, why doesn’t every surgeon use this approach? The answer is that the surgical pathway is significantly more complex. With an inframammary fold incision, the surgeon can access the breast pocket directly through an incision beneath the breast, making visualization and access relatively straightforward. In contrast, the transaxillary approach requires the surgeon to navigate a much longer route from the armpit to the breast. Creating the implant pocket also demands a high degree of precision, often with the assistance of an endoscope to carefully visualize the surgical field throughout the procedure. For this reason, the armpit approach is widely regarded among surgeons as a more technically demanding operation that requires a higher level of skill and experience.  
  
The choice of incision is not simply about where the scar will be located. It also involves anatomy, surgical planning, and the surgeon's experience with a particular technique. What feels like the ideal option for one patient may not necessarily be the best fit for another.  
  
**If you were considering surgery today, would you be comfortable with a scar hidden underneath the breast fold, or would you prefer an armpit incision even if it involves a more technically complex approach? We'd be interested to hear what influenced your decision!**

If under-breast incisions are considered the worldwide trend, why are so many patients still opting for armpit incisions?