Despite struggles in the economy, breast augmentation has continued to be the most popular cosmetic surgery procedure among women, and it is a procedure that comes with choices. Today I will address one of those choices: placement of the incision and subsequent scar.
The appearance and location of the scar is important, but the most important factor that determines how good you will look is the precise development of the surgical space, or "pocket", that will contain the breast implant. It is only logical that any incision that gives better access to this "pocket", especially the lower part of the breast where the final shape is so important, would be preferred.
The incisions in the breast fold (infra-mammary) and along the boarder of the nipple (peri-areolar) provide the easiest and most direct approach to the implant "pocket", and in my opinion are the best options for a breast augmentation that will give consistently excellent results. An excellent result is possible with any technique, but the key is getting a result that is not only outstanding but consistent and repeatable. The breast fold incision has the added advantages of being able to place the scar in a crease that is hidden even without clothes, and it is the only incision that can be used with most silicone gel implants. It is rare to have to redo a breast augmentation because the scar is not acceptable.
There are other options for scar placement in breast augmentation: through the armpit (trans-axillary) or through the navel (trans-umbilical augmentation, or TUBA). However, both approaches create scars that, while they are off the breast, they may be noticeable. Also, the surgical creation of the implant "pocket" is performed down a long tunnel, and in the case of the armpit approach, it is possible for the breast implant to slide back up this tunnel. Neither approach will accommodate a silicone gel implant, and operating in a tunnel makes a simple and straightforward procedure more challenging. I certainly believe that a skillful surgeon can get an excellent result with either of these techniques, but no matter who you are, the harder the surgery is to perform, the more likely it is for a surgeon to get a less than desirable result.
Every plastic surgeon believes that his or her approach is the best, but with this information you will be better able to make the choice that is right for you.