Breast implants can be placed through incisions made under the breast in the crease, around the areola, in the armpit, or through the belly button.
Each incision has advantages and disadvantages. I prefer the incision in the breast crease. It is impossible to see unless the woman is lying down nude. If done properly, even when she is naked the incision should be hard to see. The operation is simplest in this location. Simple is good for the doctor, and good for the patient. Simple translates to a lower chance of complications. Specifically, this location is associated with the lowest chance of a misplaced implant.
An incision made around the areola will be visible when the woman stands up naked. This location is no longer popular. While the armpit incision waxes and wanes in popularity, it has many associated problems. It eliminates scars from the breasts -- but it moves the scars to a more public location, under the arm. The scar is totally visible when the woman wears a bathing suit or a sleeveless shirt or dress. In 5% of people, the scars are red and raised. Even if the scars are perfect, little hair will grow along them, creating a noticeable rift in the stubble. A few women develop a numb area on the inside of their arm, and a small number will sustain a more serious nerve injury. Surgery performed through these incisions is harder to make symmetric; one breast could be higher than the other or off to the side. Finally, to assure a safe surgery, the scar must be longer than if made under the breasts.
The incision through the belly button is ill founded. Besides adding unnecessary difficulty to the operation, this Trans-Umbilical Breast Augmentation (TUBA) requires the implant to be pushed through a tunnel into the breast pocket. The necessary steel instruments could injure the implants, creating weaknesses that could lead to early rupture. Implant companies do not encourage this technique. Yet there always seem to be plastic surgeons who swear by it. They claim that complications are rare. What if furious bleeding starts in a blood vessel over a third of a meter away from the incision? It is only a matter of time until this type of disaster claims a life.
Another technique involves placement of the implants through a tummy tuck incision, at the time of a simultaneous abdominoplasty. It is technically a difficult procedure, with longer operating time and more potential for complications.
More Answers from Arthur Perry, MD