Infra-mammary (Crease) This incision was once the most common incision placement chosen by surgeons.  It is also usually reserved for silicone breast implant placement, especially in the larger sizes.   Although some surgeons will place silicone filled breast implants with the peri-areolar incision method.  The infra-mammary incision is made within the fold of the natural crease below the lobe of the breast or above it.  The incision may be anywhere from under an inch to 2 inches depending upon the elasticity of your breast skin and the size of the implant being placed.  Implants can be placed either under or over the pectoralis major with this incision. Incisions are usually larger for pre-filled implants and textured surfaces.
Peri-areolar (Nipple) This incision is very popular and is requested by many patients due to its inconspicuous placement.  The incision is made anywhere along the border of the areola, the disc of colored skin which surrounds the nipple.  Many patients fear loss of nipple sensation with the peri-areolar incision.  However, when your surgeon is very precise in his incision, being careful not to sever the main nerves and blood supply, very little long-term loss of sensation is usually experienced.  Implants can be placed either under or over the pectoralis major with this incision.
Trans-Axillary or Armpit The trans-axillary or armpit, incision requires the use of an endoscope (which is a camera on the end of a flexible tube) and with the use of a monitor your surgeon is able to see inside of your body.    Dissection and implant insertion is performed endoscopically.   This method is more common when a surgeon is placing your implants in a full -sub-muscular position.  Implants can be placed either under or over the pectoralis major with this incision.  This method also allows full sub-muscular placement without the cutting of certain muscles.
Trans-umbilical, TUBA (Belly Button) The TUBA method is also performed endoscopically and is not commonly offered.   Surgeons must be specially trained in this method and be proficient in endoscopic surgery.  A small incision is made within the confines of the navel and the tissue is dissected to the area near the bottom of the breasts.  Your surgeon then dissects the tissue in a Y fashion to the crease of each breast fold.   Pocket dissection and implant placement is performed by the use of special tools and the empty breast implant (only saline implants can be used) is rolled up and maneuvered into its rightful place.  With fill tubes attached, once the implant is placed your surgeon then fills the implants to their desired volume.  The recovery period is reported to be much faster and the scar is practically invisible.  It is a myth that breast implants cannot be placed in the sub-pectoral position with the TUBA incision.

Special Circumstances
Some surgeons will offer other methods such as through the same incision when performing an abdominoplasty surgery, or tummy tuck.  Most surgeons will offer implantation of a breast prosthesis by the same incision needed for a breast lift, or mastopexy.  Under these circumstances, an additional incision is not necessary although many surgeons do not offer their patients implantation via tummy tuck incisions, especially if you are wanting silicone breast implants.  It is not wise to dissect the area under the natural mammary crease (under the breasts) as this can create bottoming out.  However, when a patient is opting for saline breast implants, an improvised transumbilical method can be performed. 

 

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