Plastic surgeons offer four types of incisions to breast augmentation candidates at the beginning of the 21st century. Just one, the umbilical incision, is guaranteed not to leave a scar. Also called a trans-umbilical breast augmentation (TUBA), this procedure entails the surgeon feeding an endoscopic camera through a usually unseen portion of the navel and up to the breasts, where the implant capsules can then be delivered, filled and fitted for symmetry.
Not all cosmetic surgeons are trained to perform an umbilical incision, which requires acumen with an endoscope. Surgery can take longer than the other alternatives too, due to the distance between the insertion site and the breasts. These factors may translate to a higher cost, but also an invisible scar.
During the procedure, the navel, or umbilicus, is stretched apart and a small incision of no more than 1 inch (about 2.5 cm) is made along the tissue inside. The endoscope is inserted in the umbilical incision and fed through the subcutaneous fat tissue to one breast at a time. Through accompanying tubing, the implant capsules are placed in each breast and filled with saline. The surgeon will attempt to place the capsules in exactly the same location above the pectoral muscles, then tweak the volume of the second implant to perfectly match the first.
Aside from the absence of scarring, some doctors attest to quicker healing periods with an umbilical incision. The procedure's requirement for saline in the implants is seen as a drawback though, since this liquid has a lesser reputation for authenticity than silicon. Another downside noted by many surgeons is that insertion through the navel will disallow an improvement made on the saline implant by placing it under the pectoral muscle.
The umbilical incision should not be used if the goal is to place a saline implant under the muscle or to use an implant with the best reputation for realism. To partake in these advances in fake breast technology, women must undergo one of three other incisions. The periareolar method utilizes a cut along the perimeter of part of the areola or just part of the nipple — the size and location depending on whether the implant is pre-filled with silicon or just a silicon capsule that is filled up once inserted. Other possibilities are the inframammary fold, with the incision along the creases under the breasts, or the transaxillary method, with the site concealed as best as possible in the armpits.