Choice of incision should be discussed after breast examination
There are three primary incisions for breast augmentation: in the armpit (axilla), under the breast, and around the aerolar/nipple complex. As anytime there is more than one choice, there are advantages and disadvantages to each approach.
The armpit incision may leave a visible scar, which may show when wearing sleeveless tops and your arms are raised.
The scar around the nipple aerolar area may have a higher incidence of loss of nipple sensation or feeling. Also, women with very small nipple/aerolar complexes may not be able to use this approach as there may not be enough room to make an incision big enough to pass the implant .
The scar under the breast leaves a scar on the breast, but should be well hidden under the breast. For women with very small breasts, there may not be any overhang and therefore, the scar would be more visible.
It is very important that you talk to your plastic surgeon about your concerns. If nipple sensation is very important to you you may wnat to consider the scar under the breast. If you live in Southern California and spend a lot of time on the beach playing beach volleyball, you may not want the scar in each armpit. Talk to your doctor; the choice is different for each woman.
Of the 4 incisions that are available each surgeon will have preferences based on their training and their personal experiences. I would not use the belly button because it is too far away from the breasts to make extremely accurate pockets with no bleeding. This is what you need to have for an excellent result. The inframammary crease incision is excellent and any revision can be done through it if ever needed. The infraareolar incision also works well for the right patient. In my practice, that is a patient with sharp edged areolae of proper diameter and where the inframammary crease is vague or needs to be lowered. I am not a fan of the armpit scar because of several inaccurate pockets I have seen created by other doctors through this incision plus the risk of numbness in the upper inner arm skin.
There are multiple options, and no one option is best for everyone.
I agree with my colleague below that the umbilical scar is not the best, as it is much more difficult to accurately shape the breast from this distance, and in my opinion it does not make sense to compromise the outcome in the area of interest (the breasts) in order to have any particular scar.
The scar around the nipple (peri-areolar) is a viable alternative, and need not necessarily compromise nipple sensation, but will absolutely require dissection through your breast tissue. This dissection exposes the implant to bacteria in your breast ducts, and some theorize that this exposure may lead to capsular contracture. I think it is important to understand this, given that we do not truly know what causes capsular contracture, and that if it occurs, you will need surgery to correct the problem. It can be a very inconspicuous scar, but if you are among those in whom it doesn't heal perfectly, you will have a scar that is visible when you are out of clothes, in the most central area of your breast.
The armpit scar is an excellent option as well, but as with the belly button, it is (in my opinion) more difficult to carefully and precisely shape the breast reliably from this approach, and I have seen many secondary deformities resulting from this technique (meaning that over time, unfavorable changes in the breast shape occurred). I think that in very carefully selected patients, it is a good option, but it's not for everyone.
The scar under the breast has the disadvantage of being on the breast itself, but on the other hand has a few significant advantages (in my opinion)- because of it's location, it is NEVER seen (unless you want to show it to somebody), even out of clothes. Also, because dissection through the breast tissue is not necessary, theoretically there should be less exposure of the implant to bacteria in your breast ducts. Finally, because of the proximity of the incision to the areas of the pocket that require shaping in order to achieve the most lovely breast shape, the surgery (and getting the outcome you want) is a bit less complicated, lowering risks and increasing odds of satisfaction.
I still use 3 of the 4 incisions mentioned (don't use the belly button), but do think that for the majority of women the scar under the breast is most likely in their long-term best interests.
I would think carefully about the above and what is most important to you, and listen carefully to what your Board Certified Plastic Surgeon says about your options.
Make sure you have accurate information with incision choice
The previous post has good advice, but I have a few things to add. One is that you often see advice to avoid the periareolar incision (inaccurately called "through the nipple")because it has been associated with increased risk of loss of sensation to the nipple; this has been proven to be untrue in recent studies, so it is often the best choice. The periareolar incision does not increase the risk of numbness to the nipple.
Darker skinned patients may be prone to hyperpigmented (darker) scars, which often hide the best along the edge of the areola. When the form-stable implants (gummy bear) are available, it will be important to remember that the incision to place these needs to be larger, so the scar is longer and that may determine where it needs to go, especially if the areola is small.
For most women, short incision in the fold under breast is best for breast implants.
1) Of couse it depends on your anatomy, and there is a lot of variation among surgeons. I think for most women a short incision in the fold under the breasts produces the best results.
2) Remember, if you are not happy with your breast implants, it will be because you don't like the shape or size, not because you don't like the scars. The scars should be very short, and they fade a lot.
Most popular Breast Implant incision
I never commit to just one approach because there are so many variables that may make one approach better than the other. In general I think that the two most common are either inframammary (under the breast fold) or periareolar (along the border of the areola).
Breast implant incision a matter of opinion
As you can see by the difference in the answers here, the answer is a matter of opinion. I usually use the periareolar (in the pigmented area around the nipple) or inframammary (under the breasts). There is a discussion of risks and benefits and the choice relates to the patient's preferences...at least in my practice.
After you have considered the options and discussed them with your surgeon, choose the one that seems right to you. You have been given a lot of advice and now the choice is yours. Most surgeon don't recommend one site but they can tell you which one they do the most.
The one incision site that is most requested by my patients is the inframammary fold site.
Most patients choose inframammary
Natylu: I have had training and experience in several parts of the country, and I compare practices with colleagues throughout the US. My impression is that the inframammary (under breast, not actually in the fold) approach is the most common.
The other choices mentioned by other surgeons can all work well in the right patient by an experienced surgeon. That does not mean that any one patient will be able to choose any incision approach and obtain the same results. Some internal modifications can only be done through incisions on the breast.
If you are considering surgery, don't make consensus the reason for choosing your incision. Discuss your concerns and the relative advantages of the choices with your surgeon.
The most common incision site is in the breast fold. It is the best hidden, easiest access to any pocket, most versatile and easily used again in the future for implant replacement if needed. Other incision sites are around the areola which is the second most common, then the axillary incision and some may use the umbilical approach. Each has its own benefits depending your preference but make sure you go over all the options with your surgeon. Remember in the end you will have a scar no matter what. Just think about where you expose the most - your armpit/belly button or breast area? Most would say that their breasts are covered the most. Therefore, a scar under the breast will be the most concealed.