Can Breast Augmentation with Silicone Cohesive Teardrop Implant Be Done with Transaxillary Incision?

Can Breast Augmentation with Silicone Cohesive Teardrop Implant Be Done with Transaxillary Incision?

Doctor Answers (11)

Absolutely! Transaxillary approach with highly cohesive Natrelle 410 or Sientra implants is the only way to go!!!

+2

The transaxillary approach is very misunderstood.  It is much more difficult and technically demanding then directly accessing the breast through an infra-mammary approach or through the nipple.  This is the main reason that most surgeons think it is too difficult or frankly impossible.  In my opinion it just does not make sense to place a scar on the breast in an aesthetic elective procedure unless a lift is needed.  For primary augmentations with class I-II ptosis I exclusively use the transaxillary Cold-Subfascial Breast Augmentation TM.  What this means is that I access the interface of the pectoral fascia and pectoralis major muscle through the axilla (arm pit) and carefully dissect the fascia from the muscle.  The implant goes under the strong supportive fascia and above the muscle.  This is VERY different from "above the muscle" or subglandular techniques which typically do not fare well.  The fascia not only shapes the breast beautifully but the muscle is out of the picture allowing the breast implant to sit naturally more medially than dual plane techniques and it also offers the implant lasting support to prevent bottoming out and undesirable changes.  Live surgical videos have been published on the technical aspects of the Cold-Subfascial Breast AugmentationTM where the delicate dissection can be observed.  

Even the product representatives may believe that transaxillary placement is too difficult or impossible but these beliefs are remnants from early experience decades ago with saline transaxillary augmentation with a 2-3 cm incision.  The reality is that an endoscope it not necessary and the axillary incision heals and nearly disappears in most women and a larger incision in the axilla can be shortened and hidden with suture technique.  

 

I hope this helps,

 

All the best,

 

Rian A. Maercks M.D.

I


Miami Plastic Surgeon
5.0 out of 5 stars 31 reviews

Transaxillary "gummy bear" Breast Augmentation

+2
I have performed thousands of transaxillary augmentations over the last 27 years and have been involved in discussions involving the tear drop cohesive gel ("gummy bear" / 410) implant as a member of Allergan's Novo breast aesthetic council. With that said, I would never attempt to place one of these implants via the transaxillary route. Besides obvious physical challenges of insertion, the pocket must be a perfect fit for the implant and not over-dissected to avoid rotation. This is difficult enough with the incision in the breast crease and impossible through the underarm regardless of the level of experience. Stick with proerly placed standard "round" gel implant and you should end up with a teardrop shaped breast.

Lawrence W. Shaw, MD
Arizona Plastic Surgeon
5.0 out of 5 stars 52 reviews

Trans axillary incision for breast implants

+1

This is the ideal approach for patients with very youthful-appearing breasts, who do not require correction of significant breast asymmetry or major alteration of breast shape (such as tubular breasts). When the breasts are small and perky, the inframammary fold is clearly visible and it therefore does not conceal a scar very well - and sometimes not at all. If the areolar diameter is small, then a peri-areolar incision is not practical. So patients with small, perky breasts and small areolar diameters are best served by an incision in the underarm area, also known as the transaxillary approach.

Placing an implant through this approach is technically more challenging and requires the use of an endoscopic camera and endoscopic surgical instruments. Make sure the surgeon who offers you an augmentation through this approach has a great deal of experience with it. The axillary incision must heal in a warm, moist environment, and it therefore takes longer to fade to the point that is difficult to see. Patients tend to be a bit self-conscious about raising their arms above their head while wearing a swimsuit for the first six to nine months after surgery, but by one year postop most have a scar that is difficult to discern even on close-up examination of the underarm area. 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 40 reviews

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Can a gel implant be placed through a trans-axillary incision.

+1

Technically this could be done, but I think it is a bad idea.  In my experience, the transaxillary approach is riskier for infection and, to be done correctly, must use a very small incision and an endoscope to create a small tunnel.  If not, the implant always works its way into the axilla when the patient is lying down.  I think it can be done with a saline implant, because the implant is inserted in the deflated state through a very small tunnel.  However, gel implants are already filled.  By definition, the tunnel was big enough for the implant to go in, so it will always work back toward that direction.  A form-stable implant compounds this problem.

 

Dustin L. Reid, MD
Austin Plastic Surgeon
5.0 out of 5 stars 54 reviews

Tranaxillary approach for tear drop shape form stable implants

+1

It would be a bad idea to place a form stable cohesive tear drop shaped silicone implant due to few facts. The implant is difficult to insert from that anatomical area since it is not compressive and would require a large incision. To place the implant properly and to avoid the rotation or "flipping" of the implant the pocket needs to be created in specific manner that is very technically challenging.

Smooth round implants work well what was the reason for using the stable form implant?

 

Best of luck

Tal T. Roudner, MD, FACS
Coral Gables Plastic Surgeon
5.0 out of 5 stars 80 reviews

Almost anything CAN be done...

+1

the real question is...should it be done?  The silcone cohesive teardrop implant is not currently available for general use in the U.S.  Technically, the operation can be done, and perhaps the use of a breast funnel, which I use on a regular basis for breast augmentation cases, will allow access with a reasonable sized incision.  The fact is that the implant is too new to get and its results, indications for its use and long term benefits have yet to be determined.  Good luck!

Kenneth R. Francis, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 31 reviews

Breast implants via armpit

+1

Cohesive gel implants are still not approved for general use by the FDA.  While a transaxillary approach is one way to place implants, the size of the incision to accommodate a textured cohesive implant would be quite large.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Teardrop Gummy Bear Implants

+1

Hello Brooklyn,

Although transaxillary augmentation is an excellent way to place the implant, the 410 or CPG implants contain a stiffer gel that can be fractured if they are folded upon themselves when inserted through a smaller incision.  These implants can only be placed via a 4 to 5 cm inframammary incision.  In general, inframammary incisions are great if you are fair skinned.

Conversely, most women do not necessarily need a shaped/teardrop implant and would do great with a conventional cohesive silicone gel implant, which are currently the only FDA appproved silicone gel implants, and they are easily placed through a transaxillary incision.

So you have potentially two choices. Either enter the gummy bear study and have an inframammary incision, or get conventional cohesive gel implants via the transaxillary incision. Only you and your surgeon who has examined you can best guide you to making this decision.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 28 reviews

Tear drop shaped breast implants have problems and no advantages.

+1

Hi.

They sound good but don't give you better results.  Very few plastic surgeons use them.  Not a good idea.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Can Breast Augmentation with Silicone Cohesive Teardrop Implant Be Done with Transaxillary Incision

+1

First of all, how many consultations have you had? I think it might be wise to speak with some other surgeons. If you have been following discussions about teardrop shaped implants on this site you will have seen that few doctors still use the teardrop implants since they provide no significant improvement over the round smooth implants if they stay properly positioned, but if they rotate as happens occasionally, the teardrop look is quite bizarre. And as to the axillary approach, it would be very unwise to attempt that.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 13 reviews

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