Breast enlargement through nipple or under the muscle, which do doctors prefer and why?

Dear lisatran32084,I recommend a comprehensive scar management program after your breast augmentation procedure. We specialize in minimal scars. Its starts with a peri-areolar incision that hides the scar at the border of the areola. Next, I close my incisions in 5 layers and take stitches out week one and week two.  I don't recommend absorbable sutures because they cause inflammation that worsens scars. Then we tape your incisions once a week for 6 weeks. Lastly we start you on a 3 month topical scar management protocol with a scar gel thats FDA approved. Mederma, FYI, has no proven clinical efficacy so I would not waste your money on that product.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Good results may be
obtained with both types of incisions, periareolar or inframammary, depending on individual anatomy, a
patient's concerns and desired outcome. Implants can be placed under the muscle through either incision. There are pros and cons of each:Periareolar: The incision which goes around the
edge of the dark areola that surrounds the nipple (usually the lower half) is
used to insert the implant.Pros:The scar usually blends wells well with the
surrounding tissue. • The same incision can be used again if later
surgeries are needed.• The space for the implant can be seen clearly
with direct vision.Cons:• The incidence of infection after surgery may
be minimally greater.• Breastfeeding in the future may be interfered
with in some but not in most patients.• Nipple sensation may be decreased, but it is
usually temporary.• While the scar usually blends in at the edge
of the areola, there is also a chance it could be lighter or darker than the adjacent
tissue.• If the areola is too small, the incision may
not be a good option for larger silicone gel
implants.• Potential slightly higher risk of capsular
contraction.Inframammary: The incision is placed at the
bottom of the breast near the crease called the inframammary fold.. This is the
most commonly-used incision today.Pros:• The same incision can be used again if later
surgeries are needed.• The space for the implant can be seen clearly
with direct vision.• Slightly lower risk of infection.• While it is a visible scar, the position
underneath the breast in the fold means it is usually not visible while standing without clothes.• Potential slightly lower risk of capsular
contraction.Cons: • The scar can be visible on the breast when
lying down.• Placement higher or lower on the breast will
make the incision visible. • If there is a secondary procedure to place a
larger implant, the scar may be located higher
on the breast. If a smaller implant is placed, the crease may be raised, exposing the scar in a lower position,
possibly in view under a bra or swimsuit. • Longer appearing incision than around the
areola.• May not blend in as well as a periareolar
scar.Keep in mind that following the advice of any
surgeon on this or any other web site who proposes to tell you what to do
without: examining you, physically feeling the tissue, assessing your desired
outcome, and taking a full medical history, as well as discussing the pros and
cons of each operative option would not be in your best interest. I would
suggest that your Board Certified Plastic Surgeon be certified by The American
Board ofPlastic Surgery who is ideally a member of the
American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are
comfortable with. You should discuss your concerns with that surgeon in person.
That way, you can have a better idea what is safe and makes the most sense for
you.Robert Singer, MD FACSLa Jolla, California