Editor’s note: the attached video includes graphic footage of surgery.

For nearly 15 years, saline implants were the only option available to breast augmentation patients until the FDA re-approved silicone implants for cosmetic procedures in 2006. Although patients had limited choices, saline implants not only offered a track record of safety, but also the added benefit of flexibility, since they are not pre-filled.

Because they were deflated during insertion, doctors found they could utilize a variety of new techniques for inserting the implants that resulted in smaller incisions and less scarring. This meant that the scars could be placed in several areas; some more subtle or hidden than others.

Today, those techniques are available for all kind of implants — silicone as well as saline — and it’s important to know what kind of technique your surgeon will use, and the risk and benefit of each.

Inframammary: This incision is made where the breast comes together with the chest wall. A correctly placed incision means the scar is only visible when the patient is lying down.  One advantage to this approach is if the surgeon has to go back in to correct any complications, no other incisions need to be made. The breast tissue, muscle and implant are all accessible from this incision. A disadvantage to this incision site is placement; the surgeon must determine where the new crease will be, not where the old breast fell. Also, if the patient decides to either have the implants removed or go up a size, the old incision will be visible.

Periareolar: This incision is made around the bottom half of the areola. This incision is commonly used in patients receiving a breast augmentation and lift at the same time. It also allows the surgeon to work close to the breast, making placement of the implant easier. The main disadvantage to this type of incision is that muscles and connective tissue must be separated during surgery, and that causes additional discomfort during recovery. Also, since the entry point is so close to the areola, the risk of losing sensation is greater.

Transaxilary: The transaxilary incision leaves no scar on the breast itself but instead in the patient’s underarm. This technique allows for implant placement above or below the muscle, and usually results in fewer breast feeding complications for women who go on to become pregnant. However, this type of incision cannot be used with silicone implants, makes placement more difficult since the surgeon is farther from the breast, and complications have to be addressed with additional incisions, if needed.

With any of these techniques, and with any kind of implant, patients will experience soreness for two to three days as their body gets used to the change. Most patients are able to return to normal activity in a week.