There are several things to consider when deciding on which incision you use to perform your surgery. Cosmesis and the resulting scar are certainly an important consideration. Another consideration is the risk for capsular contracture. When a foreign body is placed in the body, the body reacts by forming a capsule of tissue around the foreign body. In the case of breast implants, this capsule can be soft or it can become hard and even painful. They can even distort the implant and result in poor cosmesis. This is termed a capsular contracture, and the rates of these can be quite high, depending on implant choices and incision type.
Recent evidence seems to indicate that there are higher rates of capsular contracture with peri-areolar (nipple) and trans-axillary (armpit) incisions. Using an incision in the fold under your breasts (IMF incision or inframammary fold incision) seems to be associated with the lowest rates of capsular contracture. The cosmesis of this incision is also ideal as it is hidden under your breasts. Armpit incisions have the potential of being seen every time you lift your arms.
The IMF incision also provides the surgeon with the best approach to perfect your implant pocket, alter the IMF if needed, and obtain hemostasis. Much of the armpit approach involves blind and blunt dissection.
I hope this helps. Good luck!
Asif Pirani, MD, FRCS(C)
Plastic & Reconstructive Surgeon