What are the different incisions that can be made?

When it comes to incisions, you have multiple options.

Your surgeon can perform your breast implant surgery in several different ways. It’s a good idea to talk over the various incision options, since the type of incision can affect lots of things, from scarring to future breastfeeding.

Let’s look at the pros and cons of each.

Periareolar Incision
What it is: The incision is made along the areola complex, which is the darker skin that surrounds your nipple. (This sometimes mistakenly called "through the nipple.")
Pros: This is arguably the most common approach for inserting breast implants because it lets the surgeon both see and access the areas under the glands and under the muscles. Also, the scar often blends in less conspicuously where the darker skin of the nipple meets the lighter skin of the breast. Typically, the incision goes halfway around the areola. Many surgeons use this incision with good results.
Cons: Some early studies have suggested that the periareolar incision increases the chances of sensory changes to the nipple — though more recent reports have refuted this assertion. No matter what incision the surgeon uses for your breast implant surgery, numbness, or partial sensory loss to the nipple, is always going to be a factor. Some surgeons believe there is a higher risk of infection with this approach, since bacteria in the milk ducts of the breast tissue might be exposed. However, this also remains unproven. This type of incision also cuts down on the likelihood that you’ll be able to breastfeed in the future.

Inframammary Incision
What it is: An incision in the fold beneath the breast.
Pros: The inframammary incision is another common approach. However, you need to be sure that once your implants are in, your breast will definitely fold over, and cover this scar. If so, this may be the best approach for you. Also, you have a higher likelihood of being able to breastfeed in the future if your surgeon uses this incision.
Cons: The inframammary incision scar tends to be slightly more noticeable and visible than the scar from the periareolar or transaxillary approach because it is not "camouflaged" by the change in skin color. Also, because of how gravity affects your breast, the scar may tend to migrate upward and might become pretty noticeable on the breast itself. If a noticeable scar on your breast is your worst nightmare, then this approach is not for you.

Transaxillary Incision
What it is: An incision made through the armpit.
Pros: The transaxillary incision may give you the least noticeable scar (or at least a scar that is not as near the breast). It’s performed with an endoscope (a pencil-sized rod with a fiber-optic camera on the tip), and many surgeons achieve excellent cosmetic results. This approach is a good option if your surgeon is placing your implants under the muscle. Some plastic surgeons swear by this approach and they are extremely competent with it. However, most surgeons use this technique only for smooth implants that are placed under the muscle. Using the transaxillary incision to place textured implants above the muscle is a much more difficult procedure (from a technical standpoint) and many surgeons don’t offer it. This incision may also a good option if you are planning on trying to breastfeed in the future.
Cons: One potential drawback of the transaxillary incision is that you might see the scar under your arms if you wear sleeveless dresses or bathing suits (especially when you raise your arms). No other breast implant incision is visible when clothed. Additionally, the surgeon can go through a previous periareolar or inframammary scar time and time again if you ever need another surgery. (Approximately 20 percent of women will need a second surgery sometime in their lives.) You generally cannot go back through an axillary scar, which means the surgeon will need to make a new incision, which may mean another scar. Finally, bleeding can be difficult to control when using this approach, and there could be nerve damage, which will affect both the movement of and sensation to your arms and hands.

Transumbilical Incision
What it is: Directly through your belly button.
Pros: The advantage of the transumbilical incision is that you will likely have no visible scar.
Cons: There are four main disadvantages of the transumbilical incision:

1. It is a somewhat "blind" surgery since your belly button is very distant from where the surgeon needs to place the implants. Although the surgeon will use an endoscopic device (a tiny camera), it’s still difficult to get the correct placement of the implants.
2. Your surgeon can’t use pre-filled breast implants with this procedure, which cuts down on your options for your best cosmetic look and feel.
3. Few plastic surgeons use this approach because they don’t have enough control, and because the evidence suggests there are poor long-term results caused by not getting the new folds of the breast to the same level.
4. There is a chance of making "tracks" in a line between the belly button and the breast. These tracks form the shape of a "v," and come together at the umbilicus. They can be visible for a long time, and are not a pretty sight.

Frequently Asked Questions Reviewed by Dr. Richard Baxter in Seattle, WA. To learn more about Dr. Baxter, please go to www.aboutplasticsurgery.com/doctor-profile/richard-a-baxter-md-facs-227.