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What is the Best Incision for Breast Surgery?

There are many different incisions through which one can insert implants: umbilical (belly button), axillary (armpit), upper areolar edge or along inframammary fold (IMF). The first one was a past novelty that resulted in an increased number of implant revisions. 

The axillary approach can work out well, but it has additional risks one might want to avoid: The scar might be visible in an armless dress/shirt, the implant may fall too far into lateral chest wall or armpit, the sensory nerves may be more easily harmed, and it is associated with a slight increased chance of needing a revision. 

The areolar edge scar is a good approach if one needs a crescent lift anyway or if one might want to show the inferior breast curve of your breast in public. This is a thing for some. This approach is more acceptable in patients with less breast tissue as areolar edge surgery takes one through breast tissue which can contaminate the implant. The other downside to this approach is that all wounds heal by the laying down of scar (collagen fibers) and ALL scars contract to some extent. If the areolar edge scar contracts, it can create a visibly retracted scar on the breast surface. This only happens in a small percent of patients and is never desired. It can be fixed with surgery, but we always want to try to get everyone through surgery with only one procedure if possible. 

The last approach (IMF) is the one most people choose as it bypasses the risks of breast tissue contamination, visibly retracted scars, potentially changing the breast tissue on a mammogram and potentially changing future breastfeeding possibilities.