How do I know what incision is best under the boob or in the nipple? (Photos)

Hello,Periareolar incisions put you at the highest risk for the most common complication of breast augmentation: capsular contracture. It also cause injury and scaring to the underlying breast tissue which has a direct implant on mound shape and implant palpability. Finally, although touted as a more aesthetically pleasing incision, I can tell you that on average they are more conspicuous and thickened than ideal. Inframammary incisions offer the lowest risk of complications and reoperation and are more pleasing than periareolar incisions on average. Subpectoral implants have a lower risk of capsular contracture, rippling, and unpredictable tissue stretch than subglandular implants. Go visit a few ABPS certified/ASAPS member surgeons who specialize in breast surgery. Best of luck!

The nipple incision is referred to as a "periareolar" incision, since it's located right on the junction of the darker areola skin and the lighter breast skin. The other incision is called an "inframammary fold" incision. Both are very useful, and both tend to be very cosmetically acceptable as time passes. In recent years, the inframammary incision has become more common, due to the opinion of many breast augmentation experts (including myself) that the rate of capsular contracture is lower than with a periareolar incision,. Capsular contracture is a problem in which the tissue around the implant thickens and tightens, making the implant hard, and sometimes displacing the implant. I typically use an inframammary fold incision, but will also use the periareolar incision if the patient really prefers that approach. I almost always place the implants beneath the pectoralis major muscle. The muscle provides a thicker layer of padding or cushioning over the implant, making it less likely that an implant edge or wrinkle will be visible. 

Dear bere17,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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery