No scar on the breast. Two ways to get there.
Scarless Breast Augmentation refers to two related approaches, both offered by Drs. Larry Nichter and Jed Horowitz at Pacific Center, that place the implant without any incision on the breast itself. The chest wall stays untouched: no incision under the breast (inframammary), around the areola (periareolar), or on the breast skin at all. What remains is a small incision in a location the eye doesn't naturally look for scarring:
Transaxillary (through the armpit). A small incision (2–3 cm) placed within the natural crease of the armpit. Once healed, it disappears into existing skin folds and is hidden by natural anatomy.
Transumbilical (through the belly button). An even more discreet approach: a small incision inside the natural fold of the umbilicus, from which the implants are threaded up through subcutaneous tunnels to the breast pocket. Once healed, the incision is essentially invisible — it's inside the belly button.
Both approaches have been refined by Drs. Nichter and Horowitz over many years. The name 'Scarless' reflects the outcome from the perspective of the breast — not that there is literally no incision anywhere, but that no scarring appears on the breast tissue or chest wall. The right approach for you depends on your specific anatomy, your implant preference, and how the tradeoffs of each route align with your goals — details discussed during your consultation.
Who this procedure is designed for.
Scarless augmentation is best suited for first-time augmentation patients who place high priority on the complete absence of breast scarring.
Primary augmentation, not revision
Scarless approach works best in first-time augmentation cases. Revision augmentation typically requires access through the original incision.
Willing to consider specific implant types
Both approaches limit implant choice compared to a full-open technique. The transumbilical route is generally used with saline implants (filled after placement, so they pass through the small incision empty). The transaxillary route accommodates saline and some silicone implants; certain larger or specific-shape silicone implants may be better suited to a different approach. Which approach fits which implant is discussed during consultation.
Priority on complete absence of breast scarring
The primary reason to choose Scarless over standard augmentation is the aesthetic outcome. For patients who don't particularly care about a small inframammary scar, standard technique offers slightly more surgical flexibility.
Standard breast augmentation candidacy otherwise
All the usual candidacy considerations apply — stable weight, complete with childbearing, non-smoker, good general health.
Realistic expectations about the armpit incision
The small armpit incision is inconspicuous but not literally invisible. It heals into a fine line hidden by natural anatomy, but there is a small scar there.
Willing to travel to Pacific Center for consultation
Scarless is performed by Drs. Nichter and Horowitz — the technique's co-developers — whose practice is at Pacific Center for Plastic Surgery. Surgery is performed at NCSS.
Every scheduled surgical patient is offered a free Rest-Assure pre-operative consultation with Dr. Rand Scott personally — medical history, medication planning, and discharge coordination before surgery day.
Three stages, one procedure.
Because both Scarless approaches are refined techniques Drs. Nichter and Horowitz have developed at Pacific Center, the specifics are discussed in detail during consultation. The general principles that apply to both:
Small, remote-access incision
Transaxillary: 2–3 cm within the natural crease of the armpit. Transumbilical: a smaller incision within the natural fold of the belly button.
Endoscopic technique
Both routes use a small camera and specialized instruments to allow precise pocket dissection through the small remote incision — the same level of surgical control as open techniques, delivered without a scar on the breast.
Pocket placement flexibility
Both approaches can place implants either above (subglandular) or below (submuscular) the pectoralis muscle. Pocket placement is chosen based on your anatomy and goals, not limited by the entry point.
Implant considerations
Transumbilical is generally paired with saline implants (filled after placement so they pass through the small incision empty). Transaxillary accommodates saline and select silicone implants. Which approach fits which implant is a central topic of the consultation.
Recovery equivalence
Both Scarless approaches have essentially the same recovery timeline as standard augmentation — the difference is in the aesthetic outcome, not the recovery.
Every Scarless Breast Augmentation at NCSS is performed under physician anesthesia — no CRNAs, no exceptions — in our AAAHC-accredited operating rooms with endocrinology on call.
Two sites. One recovery.
Scarless breast augmentation recovery matches standard augmentation almost identically — the surgical scope is the same, just accessed through a different location.
Discharged the day of surgery with your dedicated nurse. Multimodal pain protocol. Some tightness across the chest, especially with submuscular placement.
Restricted arm movement — particularly reaching overhead — if the transaxillary approach was used. Transumbilical patients have arm mobility but should protect the umbilical incision. Most patients return to desk work within 5–7 days.
Progressive return to normal activity. Restrictions on strenuous exercise remain. Implants are still settling into their pocket.
Return to full exercise, including upper-body work, once your surgeon confirms complete healing of the entry incision.
Implants settle into their final position and softness. The entry incision (armpit or umbilicus) continues to fade and typically becomes essentially invisible.
Results and long-term considerations are identical to standard breast augmentation. Implants are not permanent devices; most patients will require at least one exchange or removal within their lifetime.
Every Scarless Breast Augmentation patient at NCSS is covered by our Rest-Assure program: physician anesthesia on the day of surgery, one nurse from arrival through discharge, and post-operative direct access to your surgeon — not an answering service.
The technique developers. Only.
The Scarless approach is performed on our roster exclusively by the two surgeons who refined it.
Dr. Nichter
Scarless Technique Co-DeveloperTriple-boarded; refined the transaxillary approach with Dr. Horowitz at Pacific Center.
View surgeon →Dr. Horowitz
Scarless Technique Co-DeveloperEmory + UVA under Milton Edgerton; co-developer of the Scarless approach.
View surgeon →The right starting point is a conversation.
Every consultation at NCSS begins with time — time to understand your goals, your health history, and which of our affiliated surgeons is the right fit for your specific situation.
Call (949) 644-8182Monday–Thursday, 8am–3pm · Friday by appointment only.
Related procedures.
Breast Augmentation (Standard)
Standard augmentation with more implant flexibility — the right choice when implant type or size makes the transaxillary approach less optimal.
Learn more →Rapid Recovery Augmentation
The Nichter/Horowitz refined augmentation protocol — can be combined with the Scarless approach for optimal aesthetic and shortest recovery.
Learn more →California Breast Lift®
The Nichter/Horowitz fat transfer approach — for patients wanting modest volume with a lifted aesthetic rather than implants.
Learn more →