Patients are often confused by the range of incisions that are used for breast augmentation. The four most common are: under the breast (inframammary), around the nipple (periareolar), under the arm (axillary) and in the navel (umbilical).
None of these incision is perfect. Each has good and bad features. It is not always possible to get the incision exactly where it is planned. Most scars are about the same length, 5 cms (2 inches), because this is the length needed to make the pocket and put the implant in good position.
The most widely used incision is on the undersurface of the breast. This has the advantage that it is concealed in shadow. The surgeon often tries to place the incision not in the crease but just above, so that when the arms are raised above the head the scar does not drop below a bikini or bra line. This also has the advantage that if you want to wear an underwire bra the underwire is less likely to press on the scar and be uncomfortable. This incision gives good visibility for the surgeon and makes placement of the implant more accurate. It will always leave a scar on the surface of the breast. This incision is used for placing the implant both above and below the pectoral muscle.
Another common incision is around the nipple. The scar is placed at the edge of the areola (dark) part of the breast and the normal skin. If it heals well it is often inconspicuous but if it heals poorly it may change the shape of the nipple. It may also reduce sensation in the nipple and is not usually recommended for women who may want children and breast feed. This incision is also used for placing the implant both above and below the pectoral muscle.
The armpit, or axillary,incision is usually used for placement of the implant below the muscle although it can be used to place above the muscle. It has the advantage that if it heals well it is inconspicuous. However it has three disadvantages that make it less possible today than a few years ago. These are first it is impossible to hide so that a patient in a swim suit who raises her arms above her head will show the scar. Second, if it heals poorly it may make shaving the armpit difficult in some people. Finally, because the distance from the incision to the a common site of bleeding (the inner lower part of the breast), some patients require a second incision on the undersurface of the breast. If complications occur they are often more difficult to treat from this approach.
The incision around the navel has not gained wide popularity but may suit some patients. It is concealed in the navel which makes the scar difficult to see. However technically the surgeon must tunnel from the navel and does not visualize the pocket unless endoscopic methods are used. The implant may also be damaged in passing it into its position on the chest. This method is often used to place empty saline filled implants that are filled when in position. As gel implants return to more general use this method may be less popular. This incision is used for placing the implant both below and above the pectoral muscle, but may be easier above the muscle.