Transaxillary vs inframammary incision?

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. (I would not be concerned with pectoralis muscle retraction and the supposed limiting effects down the road)
-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-this risk can be mitigated via the use of a Keller funnel).
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 visualization of the pocket, saline implants only.
The direct approaches remain the most popular with the IMF approach most commonly used. 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).

My preference is the inframammary incision because there are less risk of complications such as malposition of implants, hematoma, implants riding high for an extended period of time. Recent research has suggested that this is the most reliable approach. The incision is very small 4cm or less.One may argue that this is a less noticeable scar than the transaxillary incision even with pigment changes.  Also I find the recovery to be less painful with the inframammary approach.Patients doing desk work can usually go back to work within 48h. Have a great day.