There are basically four incisions for breast augmentation: armpit, nipple, breast fold, and belly button. Each has advantages and disadvantages.Some are better for certain types of implants. Some are better for certain body types. There are no wrong incisions. Just different and better choices. The breast fold incision was the first incision to be performed. It is generally the simplest and can be made as long as necessary for large implants. Problems include bad scars which can’t be reversed, visible scars when a small bikini rides up and even a loss of the implant by working its way through the incision due to gravity and healing problems. The below the nipple incision is another option. The scars are hidden in the border of the dark skin and light skin. This allows excellent exposure to the entire breast especially for adjusting asymmetry and revisions. This skin really scars well. Even large implants can be placed when the incision is extended and can be closed with a crescent closure. The armpit is also an excellent method and I have performed hundreds. It works very well for saline and for smaller implants. But it is a long way to the chest muscle because of the release of the muscle can be difficult to get the implants to drop enough. The biggest issue with this incision is a possibility of the implants riding up and inability to put in large implants. The umbilical is the newest incision and only a few surgeons use it. Its use is limited to saline implants and can cause asymmetries due to the distance from the incision. In experienced hands you can get good results. Silicone implants can not be placed through the long tunnel from the belly button to the breast. It therefore has limited uses in modern-day breast implant surgery. Which incision do I favor? My most frequent choice is the under the nipple incision. This gives excellent exposure, good visualization of the muscle for release, works great for secondary procedures, and gives excellent scars. I have put in up to 700 CC silicone implants with this incision. It’s a workhorse in my practice. In selected patients I will do an axillary or inframammary incision. The umbilical incision is a long run for a short slide and I do so few saline implants these days that this is not an incision that I use.