Several types of incisions can be made, and the doctor will help the patient with her choice.
There are four ways to insert a breast implant: through the crease under the breast, through the areola (the colored skin around the nipple), through the armpit, or through the navel.
Placing the scar in the crease under the breast requires experience to place properly. Because the crease is usually lowered, the incision must be made lower than the original crease. This can easily be misjudged, and many surgeons view this approach as the one most likely to produce an unacceptable scar.
The easiest method for the surgeon is probably the peri-areolar approach because the surgeon can see and feel the implant pocket. The surgeon cuts directly through breast tissue, unlike the other methods which go under breast tissue without cutting it. These areolar scars are usually well accepted by the patient. If the scars are prominent, they can be tattooed, a process in which color matched to your skin is literally tattooed into the scar. The incision should be placed inside the colored part of the nipple, not at the junction of the nipple and normal skin; this will minimize the scar.
Armpit and navel approaches require more specialized training and tools. The scars for these are usually the most acceptable. Armpit scars are often less than an inch and a half long, are high in the dome of the armpit and usually fade well over three to six months. Special hooks and other tools are used to make the pocket for the implant. Then the implant is squeezed through the hole in the case of a silicone gel implant. For saline implants, the shell is rolled up like a taco, slid into place, and filled through a tube with the sterile salt water. When the tube is removed, a valve on the implant closes to prevent leakage. For the navel method, an instrument is inserted through an incision in the navel all the way up under the breast. Then, special tools are used to make the pocket, and the saline implant is inserted through the tube and filled.
It should be noted that any scar can thicken and require treatment, usually injections, after the surgery — sometimes for months.
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