When considering breast augmentation, there are several options for incision placement. The most common site is the natural fold underneath the breast, termed the "inframammary fold". The incision generally is hidden except in women who had small breasts before surgery, or when lying down (such as on the beach wearing a bikini top). This is the most common choice of access incision. Alternative methods include the "periareolar" margin which is the border of the areola. This is a reasonable option when the areola has enough pigment, and therefore is darker compared to the surrounding skin, as scars are hidden very well when placed along the border between two different skin tones. Women with small or faint areolae are not good candidates. Other less common places for the incision to be made are the axilla (armpit) or the belly button. These incisions can only be used when patients have relatively small breasts and saline implants are selected. As a general rule for breast augmentation, placement of silicone implants requires that incisions are longer compared to the incisions used for placement of saline implants. This is because silicone implants are pre-filled whereas saline implants are initially deflated, and then filled once placed inside the breast.
With regard to breast reconstruction after mastectomy, implants are inserted through the mastectomy incision and placed beneath the chest muscle. The incision placement is determined by the oncologic surgeon performing the mastectomy (depending on whether it is deemed necessary to remove the nipple or not). In nipple-sparing mastectomy, the most common sites for incision placement are the lower/outer "inframammary fold" area, or the "9 o'clock" position on the breast itself.