Nipple incision vs crease incision? What are the pros and cons of both? I'm going for 500-700 cc.

Hello,
We plastic surgeons have a strong tendency to please, to the point where we might even do what you want despite exposing you to unnecessary risk.  So we give lots of options as though they are all equal. The reality is that in 2017, we are finally drifting towards 'evidence based best practices', like all other medical specialties (imagine if a cancer doctor offered a variety of chemotherapy meds to a patient with cancer, some with better known outcomes than others!).  What this means for you is this: there is only one incision that will minimize your risk for not only the most common complication (capsular contracture), but also the least common complication (breast implant associated anaplastic large cell lymphoma), and that is the inframammary incision. It is the most common incision around the world. It is a myth that the periareolar or nipple incision is more cosmetically pleasing; on average it is actually more conspicuous, and it is frequently associated with other scar related breast mound deformities, like areolar tethering and flattening of the lower pole of the breast. Although you'll still find an abundance of surgeons who offer it (remember, they don't want you walking out their door without you booking surgery), you should say no to nipple incisions. Best of luck!

Thanks for your question,I personally prefer the breast fold incision or inframammary incision because is hidden in the breast fold and has a much lower incidence of capsular contracture that the nipple incision. Also, this approach allows introducing big sizes like 500 or 700cc if you are planning to use silicone implants. Also to breastfeed in the future the inframammary incision is ideal because will not violate your milk ducts and breast tissue as the periareolar incision can. Please make sure to contact a Board Certified Plastic Surgeon.

The choice of incision in the setting of breast augmentation is one which is made jointly by both the patient and the surgeon. Surgeons typically have their preference as do patients. 
Your options include-
The DIRECT approaches:
-IMF (fold)- (+) popular, direct access with good visualization, if placed appropriately it is well tolerated and well camouflaged; (-) the scar can migrate as the fold descends with augmentation, the incision can be misplaced
-Infrareolar- (+) commonly used alternative to the IMF incision, the location is more consistent and predictable than the IMF, especially useful in those patients with a poorly defined fold; (-) there is a limitation based on the size of the areola (smaller areolas will limit incision size and thus impact visualization), this technique is also associated with slightly higher rates of contracture (due to the contention that there is low grade contamination associated with passage through breast tissue).
The INDIRECT approaches:
-Transaxillary (armpit)- (+) avoids a scar on the breast mound but must be performed endoscopically as there is no direct visualization of the pocket during dissection otherwise; (-) can be limiting with regards to implant size and type (although the Keller funnel has helped); saline is preferred, however, smaller silicone devices with a funnel are possible; form stable implants cannot be placed via this indirect route.
-Transumbilical (belly button)- (+) avoids a scar on the breast mound; (-) no direct visulization of the pocket, saline implants only.
The direct approaches remain the most popular with the IMF approach most commonly used. The incision choice has very little impact on pain or recovery (this is more a function of augmentation plane). Augmentation, irrespective of access incision is likely to distend the areola to some degree (this is more a function of implant size).
Ultimately, no approach is perfect. They are different as is each surgeon. The incision decision is best made in concert with your board certified plastic surgeon (ABPS).