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Implants for augmentation may be inserted into the breast through one of the various types of surgical incision:

• Inframammary - below the breast fold
• Periareolar - areolar border
• Transaxillary - armpit
• Transumbilical (TUBA) - navel
• Transabdominoplasty (TABA) - navel
• Areolar Vertical Approach (AVA) - areolar border

Inframammary

The incision is made below the breast where it meets the chest at the inframammary fold. This incision is the most common approach in the UK. It is often the preferred technique for silicone gel implants due to the longer incisions being required in order to fit the implants. Inframammary incisions make the placement of the implant relatively easy. With this incision, the scars are often hidden due to the fact that the breasts cover them. Sometimes the actual scars can end up being quite thick.

Periareolar

The periareolar incision is made along the border of the areola (coloured circle of skin around the nipple). This type of incision is typically made when either adjustments to the inframammary fold position are required or a breast uplift (mastopexy) is required. The incision is generally placed around the bottom half of the areolar border.

Silicone gel implants can be difficult to place via this incision due to their size and the length of incision required, around 5cm. Scars from this incision occur on the edge of the areola and so they are often less visible than scars from inframammary incisions. There is a higher incidence of capsular contracture with this technique.

Transaxillary

The transaxillary incision is made in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast and is more likely to consistently achieve symmetry of the inferior implant position. Revisions of transaxillary placed implants may require inframammary or periareolar incisions. Transaxillary procedures can be performed with or without an endoscope (a very small video camera that can be inserted the body).

Transumbilical (TUBA)

A less common technique where the incision is made in the navel and dissection tunnels upwards towards the breast. This approach enables implants to be placed with no visible scars on the breast but makes appropriate dissection and implant placement more difficult. Transumbilical procedures are performed with or without an endoscope to assist dissection. This technique is not appropriate for placing silicone gel implants because it is impractical to physically fit them through the small 2cm incision. There would also be a risk of damaging the implant shell.

Transabdominoplasty (TABA)

The transabdominoplasty incision is similar to the TUBA incision. The implants are tunnelled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty procedure.

Areolar Vertical Approach (AVA)

The areolar vertical approach is a very similar approach to the periareolar as the incision is the same. However, the AVA leaves a more extended submuscular pocket for silicon gel implants, through the transglandular section to the top pectoral fascia. The cavity is drained after being washed with saline solution before the implants are placed. This technique developed in Argentina was proved to have excellent results even after numerous long term surgeries.