I am considering breast implant exchange for a smaller size. Which incision options are there besides the key hole method?

Dear CinCin45,
I tend to prefer the periareolar incision because its the most well hidden. There is a natural border between the areola and the rest of the breast skin the hides the incision extremely well. You have to be completely naked to see it vs other incisions like transaxillary and inframammary are visible in clothing such as sleeveless shirts and bikini tops when extending your arms up. I've also noticed increased rates of bottoming out with inframmary incisions that is not reported. Transaxillary implants are always wide in appearance because the surgeon is not able to dissect medially enough to provide better cleavage. Ultimately, I can perform any of the incisions but I recommend the periareolar. There is no difference in sensation because the nerves that control nipple sensation come in laterally from the back and injury to them occurs when surgeons dissect to far laterally which is why transaxillary incisions have the highest nipple sensation disruption. There is no difference in breast feeding ability. One study did show a slight increase in capsular contracture with use of periareolar but that study was small and did not incorporate modern techniques such as below muscle placement, keller funnel usage and triple antibiotic irrigation.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

How much lift is needed will determine what kind of incisions needed. You did not post any photos, so I cannot be specific. I would suggest going back to your surgeon and discussing your options. There are radiofrequency skin tightening options with minimal incisions for some ladies.

If the only point of the operation is to exchange implants, then the surgeon should go through your previous incision.
Other surgeries are done at the same time, such as a breast lift, then that changes the equation based on what your needs are.
Your question seems a bit out of context and you didn’t include pictures, so I don’t think you’re gonna get a meaningful response. Exchanging implants is almost always done through the primary incision that the implants were placed through.
The only exception is if the implants with placed through the axilla or umbilicus.
If that’s the case, it should’ve been indicated.
Follow up with your plastic surgeon or schedule second opinion consultations with other providers in your community to get a better understanding of surgical options.
Best,
Mats Hagstrom, MD