Natural Looking Breast Implants with Transaxillary Incision?
- Asked by Thea in CT in New Haven, CT
- 4 years ago
I see many photos of underarm incision for breast implants, and the implant placement looks oddly high and often misplaced. Also, many surgeons won't use this incision.
Is it possible to get a natural look with the underarm incision for silicone breast implant? I am a first time patient, size A, looking to increase to full B.
Absolutely! Transaxillary Subfascial approach with highly cohesive Natrelle 410 or Sientra implants is the way to go!!!
Absolutely! Transaxillary approach with highly cohesive Natrelle 410 or Sientra implants is the only way to go!!!
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. As far as riding high, this is technical error. The entry dissection through the armpit has to be done thoughtfully. The lymphatics that drain the breast are nearby and should not be disrupted for the future possibility of cancer staging/lymph node detection. To avoid the lymphatics, one must stay high and avoid traversing the surgical axilla. If this is done, there is geometric isolation between the entry dissection and the implant pocket and the implant cannot ride into this area. The second reason that implants may ride high is that it is more technically demanding to develop an accurate and well designed inferior pocket. Most of these problems occur when an endoscope is used and the actual placement on the body is overlooked in favor of concentrating on the endoscopic monitor.
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.
An experienced surgeon can make breasts look natural through a transaxillary incision
Unless the breasts have some pre-exisiting ptosis (droop) prior to the breast augmentation, there should be no reason why breast augmentation performed through a transaxillary (armpit) incision should not look natural.
You mentioned in your question, that often they look to high when you see before and after pictures of augmentation performed through the transaxillary approach.
This is a common mistake with the transaxillary approach. The surgeon must have the experience to know to initially place the implants slightly lower through the transaxillary approach then through the peri-areolar or inframammary approach. When properly performed, implants can look perfectly natural through the transaxillary incision.
Trans axillary breast implant are great, it depends on the surgeons experience.
While over the past few years I have come to prefer peri areolar incisions and the placement of textured silicone gel implants there is no question that in a surgeon who has mastered the technique trans axillary sub muscular implants will give marvelous results in almost all patients. In fact if I am going to use saline implants and over 80% of my patients choose these, probably for cost factors, I routinely use the trans axillary sub muscular technique. The claim that they will be too high and too far apart is simply incorrect in a good surgeons hands. So again what ever technique you choose make sure you see the surgeons pre and post op photos to assure your self that the results the surgeon plans for you are the same as what you are looking for.
Two exceptions to trans axillary sub muscular implantation in my hand are when they are done in conjunction with a breast lift and when the patient presents with tuberous breasts. Tuberous breasts are those with very small base diameters, deficient inferior breast tissue and they tend to drop off the chest like Snoopy the dog's nose. With these I feel I need to use gel filled implants behind the breast and not behind the muscle.
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Transaxillary approach gives excellent results in augmentation
Transaxillary augmentation is an excellent approach to augmentation in those individuals who are more comfortable with a scar that is off the breast. The incision in placed high in the crease under the arm and the implant slid down into a submuscular position.
This approach was very popular several years ago and has not received the attention today that it deserves. There should be no difference in the augmentation result when comparing the underarm approach, around the nipple, or a breast fold or inframammary incision. All simply provide access through which an appropriate pocket is made to accommodate the selected breast implant. Augmentation through each approach may be done well, or done poorly. Surgeons who do not use this approach may not be comfortable with it or be able to do it well and rely on what they feel is a more "direct" incision.
All incisions do fade, however you should be able to have an excellent augmentation through a transaxillary incision and avoid a breast scar if you wish.
Best of luck,
Transaxillary approach for gel implants
Natural breast augmentation result possible with Transaxillary Incision
This procedure may take a bit longer, but for some patients this incision is ideal and can provide very natural looking results. Be sure to ask for many photos of patients who have had their implants placed through this incision, and then speak with some patients and what their experience is like.
Web reference: http://www.michaellawmd.com
Consider endoscopic transaxillary approach
There are many approaches used for breast augmentation. The trans-axillary approach is especially appealing since it avoids incisions in and around the breast.
However, the only way to safely and precisely perform a breast augmentation through the axilla is to use an endoscope. In this way the pocket can be clearly visualized and proper implant placement can be achieved.
Many doctors are not comfortable with the use of the endoscope. They either do not perform this procedure or use blind, blunt dissection to create the pocket. This can result in asymmetry and high placement of the implant,
The pictures you have seen likely represent poor pocket dissection using a blind approach.
Keep in mind that generally the largest silicone implant that can be placed through the armpit is about 250cc. If you desire a larger implant, then you may have to consider a saline implant.
Good luck with your procedure.
It is possible
One of the problems with this approach is thet there is inadequate release of the muscle to allow the implant to settle into a lower, more natural shape. I assure you that there are plastic surgeons who like this approach although there are many who don't. Make you decision by looking at a plastic surgeon's before and after photos. That will tell you in general what they can achieve.
Transaxillary incision has the most problems.
Unless the surgery is done perfectly on the right patient (long distance between the nipple and the fold, with no sagging), the implants will end up too high. It is hard to make the pocket low enough through the axilla.
Let me assure you of something else. If you are not happy afterwards, it is not going to be because of the scar. Scars under the breast or under the nipple are short, and they fade, and nobody complains about them. If you are not happy afterwards, it will be because the SHAPE is not right.
There is nothing magical about the armpit scar. Go to the surgeon who can show you lots of before and after pictures with great shape.
Approach is only part of the equation
It is generally true that the transaxillary approach tends to produce implants that are too high partly because it is harder to get a good dissection at the inframammary fold from a blind, blunt technique but also that if the capsule start to get a little firm, the implant will tend to try to go back into the tunnel towards the axillary which is the point of least resistance. However, you can get an excellent result if the choice of implant fits your anatomy. Usually patients who say they are an A cup are quite tight below the nipple and a more modest size of implant is called for. If you try to go too large or wide, it might ride high. it is the combination of incisional approach, surgical technique,type and size or dimension of implant, and starting breast volume and shape that will influence the final result.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.