I prefer the under the armpit incision
I have preferred the under the arm incision with endoscope for many years, but I was always limited to saline implants when doing this procedure through small breast implants incisions. Now for the last few years I have been using the Keller funnel and I can now place a 550cc gel implant through a 4cm armpit incision.
Breast implants incision Placement
Every surgeon has his or her preference based on their experience and comfort level.I prefer placing my implant via an inframammary crease incision.
I feel that that this route allows for excellent visualization of the pocket where the implant will go into, and is inconspicuous once healed.
The breast usually hangs over the crease as the implant settles, thus hiding the incision. I prefer the under the armpit incision (Wilfred Brown, MD, New York Plastic Surgeon)
There is excellent control of the implant placement and no scar on the chest, and a very inconspicuous scar in the armpit. See video Incisions for silicone implants with small areola (Rodney A. Green, MD, Cleveland Plastic Surgeon)
Best incision for breast augmentation – small areola and gel implants
Another excellent option for you is to use saline through the peri areolar approach. Because saline implants start out empty ( as opposed to the pre-filled silicone implants), they can be placed through a tiny breast implants incision. In your photo, it seems that you could be an excellent candidate for the small incision in the areola. If a long scar is your primary concern, then saline may be a great choice for you. In my practice, saline implants through the areolar incision can often have virtually invisible scars and a fantastic result. The difference in softness between gel and saline is something to consider, but in some cases can be a minimal difference. If you really feel silicone gel implants are for you, I would favor an infra-mammary incision. (Michael Suzman, MD, New York Plastic Surgeon)
Incisions for Breast Augmentation
There are 3 incisions, inframammary fold, periareolar (in and around the nipple), and the axillary (armpit). All are acceptable, but they all have inherent advantages and disadvantages. My preference (in greater than 90% of my patients) is to use inframammary fold incisions as it is hidden in the fold and it allows for optimal correction of any breast asymmetries as it is a more direct approach and it has less chance of nipple sensory loss (which is in the 5% range).
I recommend using an areola breast implants incision if the areola is wide enough for placing an implant or if it is the patient’s preference. I use the axillary (armpit) incision, if the patient has absolutely no breast tissue, in patients with a history of scarring (patients of color), and if it’s the patient’s preference. Other than that, the inframammary fold incision gives you, in most cases, the chance for improved result, in my experience, for correction of asymmetries which are very common. (Rod J. Rohrich, MD, Dallas Plastic Surgeon)
I agree with the opinions of the others. The inframmary incision would probably be the best approach (with the least risk) for you. (Shahin Javaheri, MD, San Francisco Plastic Surgeon)
Breast implant incision choices
For 550cc implants and fairly small areola, your two options are really through the inframammary fold or the armpit. A 550cc implant will put a 4-5 cms breast implants incision in the armpit which may be more noticeable than when a saline impalnt is used through that approach. Armpit incision for breast implants has more complications. (Steven Wallach, MD, Manhattan Plastic Surgeon)