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

Good results may be
obtained with both types of incisions depending on individual anatomy, a
patient's concerns and desired outcome. 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.
There
are two choices for breast implant placement: sub-glandular (under the breast
tissue and in front of the chest muscle – the pectoralis muscle) or
sub-muscular (under or partially under the chest muscle). The best location
depends on many factors including: tissue thickness, weight, desired outcome,
and individual anatomy. Each position has advantages and disadvantages:
Subglandular implant benefits:
A shorter
recovery time.
Less
discomfort initially.
No
distortion of the breast when the pectoralis muscle flexes.
Mild
preoperative sagging can be improved, especially if no breast lifting
procedure is performed.
Easier
surgical procedure.
Larger
implants can be placed.
 Subglandular
implant disadvantages:
The implant
may be more visible.
More
visible rippling, especially in patients with a small amount of natural
breast tissue.
Generally,
saline implants do not produce a good result in front of the muscle.
Higher
incidence of capsular contraction.
“Bottoming
out” in some patients.
Some
radiologists have more problems reading a mammogram with an implant in
front of the muscle.
 Submuscular implant benefits:
Usually
results in a better appearance for naturally small breasted women
Less
tendency for seeing ripples of the implant.
A more
natural feel to the breast especially in slender women who don’t have much
of their own breast tissue.
Less
interference with mammograms, although most radiologists take additional
views no matter where the implants are placed.
Lower rate
of capsular contraction.
Less of a
chance of “bottoming out” where the implant bulges at the lower aspect of
the breast and the nipple and areolas tend to appear excessively elevated.

Submuscular implant disadvantages:
Recovery
usually takes a little longer and is more uncomfortable initially.
There may
be an “animation deformity”, which is a temporary distortion of the
breasts when the pectoralis muscle is flexed. Body builders and weight
lifters generally prefer implants in front of the muscle.
It is
harder to achieve cleavage in women who have widely spaced breasts.
The
implants often ride higher on the chest.
Actually,
most patients who have breast augmentations today have breast implants placed
in a combination or “dual plane” position. This approach has the same benefits
and disadvantages of a total “submuscular implant”, but with a lesser tendency
to ride high on the chest wall. The disadvantage as compared to a total
“submuscular implant” is a higher tendency for bottoming out.
The
ideal placement in any particular patient depends on their particular anatomy
and understanding of the pros and cons of each approach and desired outcome..
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 of Plastic 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

I prefer the incision under the breast. It heals nearly invisibly and is a more direct approach.  There are other good reasons to use the inframmary approach.  If, in twenty years from now, say you want the breasts lifted.  the peri areola incision could make the lift more risky because some of the circulation may be compromised.  Statistically the split between inframmary and periareola is probably 50/50.  Ultimately I let the patient decide.

The inframammary and the periareolar are the two most frequently used access incisions for augmentation. Excellant results can be obtained using either one. Most surgeons have a preference for one or the other. In my practice, I allow the patient to choose in most cases. In my opinion, most implants should be placed under the muscle. This provides better coverage, avoids interrupting signicant blood supply, and lowers the risks of complications from future procedures such as breast lifts, etc.