Accuracy is the key
There is a lot of discussion at the time of breast augmentation consultation regarding the scar. In my opinion “where is the best place to hide the scar?” is an important question but an even more important questions is “through which incision is breast augmentation most accurate?”
There are three main incisions for breast augmentation, around the nipple, under the breast crease and in the armpit. There are two other uncommon incision choices, through the belly button (TUBA) and through an abdominoplasty incision.
Implant pockets must be symmetric
The most important variable that determines the outcome of breast augmentation is the quality of the implant pocket created. For perfect results, these pockets have to be perfect. Not just close.
Although no plastic surgeon (including myself I hate to admit) could ever expect to achieve a perfect result every time, the odds are much better through incisions close to the implant pockets. Those being the crease incision beneath the breast and the incision around the nipple. The other incisions are great in theory but just not as accurate.
Rather than assessing the pocket size, spacing and symmetry with the surgeons gloved fingertips simultaneously, the pockets are assessed individually with a long instrument.
Imagine the task of simply writing your name. The armpit incision would be the equivalent of holding the end of a 3 foot long pen. The belly button incision would be the equivalent of a 10 foot pen in the dark.Breast incisions are more accurate
The scars around the nipple and under the fold heal very well and are generally not bothersome to patients. For saline implants, they are about 1? long, for silicone about 3?. If they are well placed they hide very well. I do not charge for scar revisions and can count the number of these scars I have had to revise on one hand!