What are the pros and cons of getting the incision through the nipple vs. under the breast?

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.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

Thank you for the question. There are several good approaches to breast augmentation surgery; different surgeons will have their own preferences. In my practice, I prefer the inframammary or infrareolar approach for most patients.    
 For patients with very little breast tissue and/or underdeveloped inframammary fold areas,  I tend to recommend the us of an infra areolar  approach. Despite what you may hear, I think most patients can have the infraareolar incision used regardless of the size of breast implants or size of areola. The Keller funnel has made the insertion of all sizes of breast implants much easier. I think that the us of the funnel has also made it easier to perform a true "no touch" technique ( potentially decreasing the incidence of breast implant encapsulation).
Also, personally, I think the advantages of the infraareolar incision far outweigh any theoretical disadvantages. These advantages include proximity to the planned dual plane submuscular pocket dissection, relatively hidden/forgiving location of scarring, coverage by clothing/swimming suit etc.
Patients undergoing breast augmentation surgery should understand, that regardless of the incision used, that scar revision surgery is sometimes necessary to improve their outcome.
  I hope this helps.