Over 10 million cosmetic procedures were performed last year—and the most popular surgical aesthetic procedure out there (by far!) was breast augmentation surgery. The technology for aesthetic surgeries has improved in leaps and bounds in recent years, and when it comes to breast implant surgery, these advancements mean more choices—lots more choices, in fact. One of the most important decisions you’ll have to make? What kind of incision your doctor will make when they insert your implants. Not sure which type of incision is best for you? You’re not alone. Keep reading to learn about the pros and cons of all four choices!Also called a nipple incision, the periareolar incision is placed at the edge of your areola (where it meets the lighter part of your breast skin)—generally around the lower half—and then the implant is inserted behind the breast tissue or underneath the pectoral muscle, depending on what you and your doctor have decided.

Periareolar Incision

Also called a nipple incision, the periareolar incision is placed at the edge of your areola (where it meets the lighter part of your breast skin)—generally around the lower half—and then the implant is inserted behind the breast tissue or underneath the pectoral muscle, depending on what you and your doctor have decided.

Pros: Periareolar incisions tend to heal quite well—because of their placement, the scar they create can blend nicely into the line between the areola and the rest of the breast. Their placement means that they won’t show under even a very low-cut top. Another plus: if your implants need adjusting or fixing later on, your surgeon will probably be able to reuse the same entry point, which means no extra scars in the future. Cons: When a periareolar incision is made, it severs some of the milk ducts and nerves in the nipple, which can affect a woman’s ability to breastfeed, as well as reduce nipple sensitivity. There are also bacteria in the nipple area that can cause infections after surgery. Also, if the incisions don’t heal as well as they should the scar might end up a shade or two lighter than the rest of your areola—or even slightly raised—which means it could be visible through a bathing suit or a tight shirt.

Inframammary Incision

Commonly called a crease incision, the inframammary incision is made in the natural fold underneath the breast (or in the location where that fold will be after the implants are in place).

Pros: Because of its proximity to the breast, an inframammary incision makes it easy for your doctor to control the exact placement of your implant. It does not disrupt the breast tissue, so the breast’s functions (like breastfeeding and nipple sensitivity) remain unaffected, and the incision location can probably be reused in the case of revision surgery further down the line. Its location underneath the breast means it probably will not be visible, even under bathing suits or lingerie.

Cons: If you want to change the size of your implants in the future, the crease underneath your breast might have to be lowered or raised—this may make the scar from your first surgery more visible than you might want it to be.

A transaxillary incision

A transaxillary incision is made near the apex of the armpit (axillary area), in its natural crease. Some surgeons use an endoscope (a tiny surgical camera) to help place the implant once the incision is made. It is traditionally done as a blind approach mostly by feel.

Pros: For most women, the biggest draw of the transaxillary incision is that fact that the scar it creates is not on or near the breast. For someone who wishes to hide their implant scars, this is pretty attractive.

Cons: There won’t be a visible scar on your breast, but there will be a visible scar in your armpit, which can potentially interfere when you shave under your arms. The incision can also cause numbness in the inner area of your upper arm.

Your surgeon may have a little trouble being precise when placing your implant, since the incision isn’t very close to the breast (it’s important to find a doctor experienced with the transaxillary approach so that you reduce this risk). It is not the best choice if the Breasts are uneven to start out or if the patient is very tall and/or has a long thorax.

Also, this incision is a one-time deal—if you want revision surgery in the future, it can’t be reused. You will need another incision.

Transumbilical Incision

The newest incision option of the four, a transumbilical (or TUBA) incision is made in the upper border of your belly button. The implants are inserted, moved up through the navel to the breasts, and inflated. Like a transaxillary incision, this can be performed with or without an endoscope.

Pros: Since the TUBA incision is made in the belly button, there is no visible scarring whatsoever; also, patients usually experience shorter recovery with TUBA incisions than they do with the other three.

Cons: Again, like the transaxillary approach, the TUBA incision’s remoteness from the breast can make placing the implants difficult. Not many doctors have mastery of this approach since it’s relatively new; and if complications like bleeding arise, or if your surgeon is having trouble visualizing the procedure, they may have to abandon the method and make an inframammary incision mid-surgery. If you want silicone implants, this isn’t a good choice; only saline implants can be used, because they have to be rolled up tightly before being placed, and are only inflated once they are in the breasts. One last disadvantage: like the transaxillary incision, the TUBA incision is a one-shot approach—if you want another breast surgery later on, you’ll have to use one of the other incision methods. With the TUBA approach, there is a higher chance of malposition of the implant than with the other approaches.

Wrap-Up

As you can see, all four of these incision options have their pluses and minuses; there’s really no such thing as one right choice when it comes to getting breast implants! Every case is different, and is dependent on a variety of factors: implant type and size, your doctor’s experience, the shape of your breasts . . . even your lifestyle. Bottom line: When it comes time to make your decision, it should be a joint effort between your and your surgeon, and it should be something that you know you’re comfortable with—so make sure you have all the facts!

Additional Resources

• http://www.nlm.nih.gov/medlineplus/ency/article/002984.htm

• http://www.realself.com/question/options-alternatives-breast-implants-incisions