If you get an areola incision, can the implant be placed under the muscle?

A plastic surgeon might be able to use a periareolar incision for retromuscular breast implant placement, but it is very difficult. This incision can a create a pale, depigmented, visible scar right in the line of sight and also  exposes the implant to bacteria within the nipple/areola tissue. For these and a few other reasons, many surgeons avoid using this incision. A small, thin scar in the crease under the breast hides very well as it mimics the crease and avoids all of the problems just mentioned. This is why it is probably the most popular incision choice by plastic surgeons and their patients alike.

The implant can be placed under the muscle from a peri-areolar, IMF and trans-axillary incision.  There a various advantages and disadvantages to each of these approaches. 

The peri-areolar approach can be very popular as the scar can be hidden at the border of the areola and the natural skin. From this approach, you can place the implant above or below the muscle.  This approach tends to be very popular in patients that have darker skin as the areolar border tends not to keloid or become hypertrophic as it may be more prone to do in other areas. 

The areola incisions are often incorporated in surgeries where patient are also going to have a lift as part of their augmentation to enhance the overall shape of their breasts. 

All three approaches to a breast augmentation can give you a phenomenal result if done correctly.  It is important to discuss with your surgeon their personal preference in terms of approach.  There are some patients that benefit from one approach versus another in specific circumstances. 

Please discuss your breast augmentation surgery with your board-certified plastic surgeon that performs a high volume of breast implant surgeries.   

The incision choice is independent of the implant placement, so yes, this is certainly possible.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search. 

Personally, An areolar incision can be hidden provided the breast has a large enough areola and short lower pole. Under the muscle is also possible.An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations. 

Hello and thank you for your question. Implants can be placed under the muscle with a peri-areolar incision.  There are several advantages
and disadvantages to over vs under the muscle.  Under the muscle has the
advantage of lower capsular contracture rates, less risk of rippling, and
better visualization with future mammograms.  Most patients say that under
the muscle also has a more natural look and feel.  The size, shape,
and profile of the implant is based on your desired breast
size/shape, your chest wall measurements, and soft tissue quality. 
This decision should be based on a detailed discussion with
equal input from both you and your surgeon.   Make sure you specifically look at before
and after pictures of real patients who have had this surgery performed by your
surgeon and evaluate their results.   The
most important aspect is to find a surgeon you are comfortable with. I
recommend that you seek consultation with a qualified board-certified plastic
surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon