Where will I have scars after breast enhancement surgery?

The 4 incisions for augmentation include the armpit, the belly button, the crease under the breast, and the bottom on the areola. The armpit and belly button are the least accurate in terms of making a perfectly symmetrical pocket for the implants because of their distance from the working area. The armpit also has been associated with numbness in the upper inner arm similar to what happens when breast cancer patients have lymph nodes removed.

Since most patients currently want silicone gel implants for their improved "feel" over the saline, the crease is the best approach followed by the areola as long as the diameter of the areola is sufficient.

As long as you don't need lifting scars, the scars from a simple augmentation should be worth the benefit regardless of their location as long as you have an excellent doctor doing the surgery.

There are 4 ways to place breast implants:

1. Under the breast
2. In the armpit
3. Around the areola
4. Through the belly button

The selection of which approach to use depends on the surgeon's comfort, implant selection, breast shape, and patient's desires.

The factors that your surgeon has to account for are:

• Silicone implants come pre-filled and therefore cannot be placed via belly button or armpit
• Saline implants come empty and are filled once they are in the body, so can be placed via any of the above approaches
• If there is a breast asymmetry or deformity (tuberous), to get a good result the incision on the breast or around the breast needs to be performed to be able to adjust the breast tissues before placing the implant
• If a breast lift is needed, implant can be placed via breast lift incision
• If there is bleeding during surgery, it is easier to stop it when the incision is close to the breast. Otherwise if there is bleeding, as with the belly button approach, another incision under the breast may have to be done.

Overall, ask your surgeon if he or she is comfortable with the approach you desire, and if not, why? Use common sense in accepting the answers.

There are 3-4 main types of incisions – inframammary, periareolar, transaxillary and, rarely, transumbilical.

What determines where the incision will go?

• Patient’s choice – Periareolar placement is easier if patient has had children, making it more likely that the areolar dimension will be adequate (3-5cm at least) and areolar skin colour contrasts visibly with rest of breast.
• Surgeon’s expertise and due regard to desired surgical outcomes – Periareolar approach is most versatile but limitations include high incidence of change in nipple sensation and reduction in breast feeding ability . Transumbilical route is not widely practised but limited to a few centres in the U.S.
• Type of implant envisaged – The average size of transaxillary incision limits the use of anatomical or prefilled implants via this approach. This also applies to the transumbilical route, which excludes the use of prefilled implants for obvious reasons. The inframammary approach is simpler and allows for placement of very large prefilled or anatomical implants.