The reason why few surgeons would offer this procedure is that it is nothing more than a gimmick!It provides the surgeon with a very limited option of saline only implants, minimal to no control over the pocket creation for the implants (the pockets are created "blind'), high complication rates, and serious lack of consistency in results achieved. The only "benefit" of this procedure is a scar in the belly button. However, if the results are poor and largely unpredictable, then the scar is irrelevant.One of the basic variables in augmentation surgery is where the scar is going to be. The important thing to understand is that their will always be a scar. The surgeons job is to ensure you achieve the best quality scar in the least visible location. Also, the surgeon should not compromise technical "perfection" by choosing a scar location that provides less control over what is being done internally to create the implant pocket and insert the implant. This is the problem with the belly button approach - the surgeon is compromising the quality of the surgery and results for the sake of a "trendy" scar.Of course, like most things in surgery you will find differing opinions over what is the "best" approach. With implant placement, only 3 incisions/scars are "commonly" used: armpit; lower areolar border; lower breast fold. Each approach has advantages and disadvantages. - Via the areolar is simply not possible when the areolar diameter is too small and therefore you are unable to pass an implant through a small access hole. Also, should the person scar badly it's not a great spot to have a bad scar - although this could be argued for all techniques.- Via the armpit approach can scar nicely, with no scar associated with the entire breast mound. However, these can scar badly and therefore can never be hidden! A bikini/bra will cover any scar on the breast mound (areolar or lower breast fold). Also, the armpit approach means that the surgeon has the least control and is furthest removed from the areas that he/she needs most control in creating the pocket - the cleavage region. In addition to this, should the patient require any further surgery then it is general not possible to re-use these scars, so the surgeon needs to create another scar (such as in the lower breast fold).- The lower breast fold incision is by far the most popular approach employed by plastic surgeons, and it is how I do the vast majority of my cases. The scar sits neatly within the lower breast fold crease. This approach provides the surgeon with the best control and management of the entire implant pocket and insertion/positioning of the implant. This scar can also be easily re-used should further surgery be required for whatever reason. Furthermore, many would consider that the areolar and armpit approach can result in potential "contamination" of the implant as these areas have a higher bacterial load than the lower breast fold region. Whilst this would logically be correct I'm not entirely convinced it is clinically true and/or relevant. However, its another acceptable argument for not routinely using these approaches.