Breast augmentation is the most commonly performed breast enhancement procedure in United States. One of the key factors during your consultation with a plastic surgeon is to determine which incision will be the most appropriate for you. There are currently four different incisions for breast augmentation. First is the periareolar, which means that the incision is performed around the areola. As you can see in this video, an incision is made and dissection continues until the proper pocket is created for implant placement. There is what is called the inframammary fold incision. The inframammary fold anatomically is the most inferior part of the breast: the fold that is beneath your breast. An incision can be placed here for direct access into the breast for proper placement of an implant. The third incision that some surgeons perform is a transaxillary incision, in which an incision is placed around the axilla and a pocket is created for implant insertion. The fourth one is what is called a periumbilical breast augmentation. In this procedure, an incision is performed above the belly button, and using a specialized instrument, a pocket is dissected bluntly and an implant is placed.
Choosing the best access depends on multiple factors. The two most commonly performed incisions are the one around the areola and the one under the breast at the inframammary fold. Each one has its benefits and disadvantages. For example, if the patient has a slight nipple or areola problem like a very enlarged areola or nipple or some sort of minor sagginess, then performing an incision around the areola is ideal, because you can not only place the implant through the areola, but also correct these potential problems without adding an extra incision. In other words, it is nonsense to put in an implant through an inframammary incision and then cut the areola or lift the breast through a periareolar approach.