Transaxillary, Subglandular Breast Augmentation? (photo)

Inframammary, Subglandular Breast Augmentation Body: The part I'm having issue with is the subglandular placement of the 450cc moderate profile plus silicone implants. Will there be a lot of swelling? Is subglandular a good position? I had a breast reduction in '08 and my scar has healed well. My plastic surgeon said I could get a breast lift and then come back and get implants, should I be ok without the breast lift? He said I have plenty of breast tissue.

Doctor Answers (14)

Ultimate Breast Lift increases projection and eliminates the need for implants

+1

You are an extremely poor candidate for transaxillary subglandular breast augmentation.  A better procedure is a new technique called The Ultimate Breast Lift.  This technique will reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Aligning the areola and breast tissue over the bony prominence of the chest wall maximizes anterior projection and may eliminate the need for implants.  Another advantage of this technique is that the weight of the breast is transferred to the underlying muscle providing long term stability and pain relief.

Best Wishes,

Gary Horndeski, M.D.


Texas Plastic Surgeon
5.0 out of 5 stars 123 reviews

Transaxillary Breast Augmentation Post Breast Reduction

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What I think IS true is that you can't simply have a subpectoral breast augmentation (based on your photos).  My recommendation would likely be for a breast lift with subpectoral implants.  As others have noted, you already have the scars of a breast lift.  So it seems appropriate to use the same incision for implants and another lift.  Good luck!

James N. Romanelli, MD, FACS
Long Island Plastic Surgeon
5.0 out of 5 stars 12 reviews

Transaxillary, Subglandular Breast Augmentation? (photo)

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I think you really need to see another surgeon. I am puzzled why a transaxillary approach when you have existing scars from the breast reduction. And placing breast implants above the muscle leads to a whole host of issues. Depending on what your goals are, you may be best served  doing a full breast lift initially. If not you could place implants at a later date. 

James E. Murphy, MD, FACS
Reno Plastic Surgeon
5.0 out of 5 stars 10 reviews

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Not subglandular

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My biggest concern after looking at your pictures is that you have a lot of drooping now.  Adding more weight to the subglandular position when your coopers ligaments have already stretched out, will only make them droop much more.  When placed under the muscle, the implant is separated from the breast tissue, and there is less weight added to the already droopy breast.  Not to mention all the other problems of subglandular, such as higher capsular contracture rate and putting more tissue between the breast and the implant for better cancer detection.  

Also, if you already have a scar that can be used for the implant under the breast, why use another scar in the axilla?  You need more breast tissue removed in the lower part of the breast, and you cant do that with a transaxillary approach.  I do most of my surgeries through the transaxillary approach, and would not use that in you.

Good Luck

Dan Mills MD FACS

Dan Mills, MD
Orange County Plastic Surgeon
4.5 out of 5 stars 16 reviews

Breast Augmentation

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I really think you should see another surgeon.  I have no idea why you would have a transaxillary incision if you already have scars from your reduction.  Looking at your breasts, I would do a full anchor lift and essentially re-do your previous reduction but instead of removing breast tissue, I would simply re-shape your breast so that you get more projection.  Depending on your goals, you may not need an implant.

Best,

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 28 reviews

NO reason to do transaxillary

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You do not need transaxillary.

Inframmammary for someone who has had a breast reduction is better. It is more precise and the bottoming out might be corrected by removing an inferior wedge.

I cannot measure you or know your exact objectives but augmentation and correction may be able to be done at one step. It would be possible nipple elevation and correction of bottoming out by inferior skin excision.

I would use a textured implant either a round gel or a newer cohesive gel shaped implant. I would go under the muscle too. The superior portion covered by the muscle I feel leads to less long term problems.

Benjamin Van Raalte, MD
Davenport Plastic Surgeon
4.5 out of 5 stars 12 reviews

Transaxillary, Subglandular Breast Augmentation?

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Many concerns! Why transaxillary?? You already have scars from he reduction. Size with inferior lifting should be considered. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Transaxillary augmentation

+1

Since you already have scars on your breast there would be no reason to make an incision in your arm pit.  I believe that would be a bad decision.  From your photos it really appears that you need a lift.  If the implants are placed just beneath the breast tissue I believe you will get more sagging as time goes by.  In my personal opinion you would be better off with implants placed behind the muscle and a breast lift if needed.

Gary Hall,MD

Gary Hall, MD
Kansas City Plastic Surgeon
4.5 out of 5 stars 24 reviews

Transaxillary, Subglandular Breast Augmentation?

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In my opinion you need the lift much more than the volume. I would strongly advise you to do the lift first. In their current location your breast seem much too low to have good results from the implants.  Also, you already have scars from a previous reduction, so when it comes time to do the augmentation if you follow through with that why not just use one of your old crease incisions.

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

This is not a good plan!

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You already have the scars of a previous breast reduction, and without examination with your arms at your side, it is impossible to advise if you need a repeat lift. This is particularly true since you wish larger breast volume, which requires implants.

It sounds as if your surgeon is saying you could have a repeat lift for improved shape and "perkiness," but may be hopeful that augmentation alone can fill your (too-loose) skin brassiere without adding the cost and variables of a repeat lift (not to mention the potential of compromised blood supply as Dr. Grzeskiewicz has so appropriately noted). This is not a trivial consideration when raising skin flaps for repeat lift and placing implants in their own surgical pockets.

This, BTW, is why your surgeon has recommended two steps--he obviously prefers axillary incisions and subglandular augmentation, and that would not be possible at the same time as a repeat breast lift because of these circulation issues.

It also tends to indicate that despite offering the option of a repeat lift first and implants later(?lip service only, if in fact you have a tentatively-scheduled transaxillary submammary breast augmentation--or was this your choice, perhaps based on cost and perceived "ease?") your surgeon is undecided if a lift is necessary/advisable, or is it that he simply prefers to perform the "quick/easy" augmentation the way he "usually" does them.

Subglandular augmentation has a much higher risk of capsular contracture from intraductal bacteria contamination of the implant pockets, and transaxillary incisions go through a warm, wet, sweaty, bacteria-rich armpit with additional increases in risk for biofilm-producing bacterial contamination of your implants. Malposition is also more common with this approach. So, the real question is WHY?

You already have scars, so avoiding a scar on the breast (the most commonly-cited reason for touting the axillary incision as "preferable") does not apply.

If, in fact, your present anatomy and wishes for a larger breast size can yield a satisfactory aesthetic outcome with augmentation alone (no lift), then an inframammary incision in your previous scar and submuscular implant placement offers the highest likelihood of proper implant position and least risk of capsular contracture. (Not to mention reducing the chance of nipple numbness, if that has been preserved following your previous breast reduction.)

If you have too much breast ptosis (droop or sag) with your arms at your side to be satisfactorily dealt with via volume-filling alone (just implants), then repeat full breast lift and submuscular implant placement at the same stage would be my best recommendation. 450cc implants will add almost 2 cup sizes to your present breast volume, which it appears your chest can adequately "handle," if that degree of breast enlargement is your wish.

Post-operative "swelling" is variable with each patient, surgeon, and procedure, but always resolves fairly rapidly, so choose the procedure with the highest chance of best outcome, not the "cheapest," "easiest," or one based on habit or preference of the surgeon.

Make sure your plastic surgeon is an ABPS-certified plastic surgeon with lots of breast experience. Something tells me you may be seeing a "cosmetic surgeon" who is board-certified in some specialty other than plastic surgery. If not, good for you, but seek an additional opinior or two from  ABPS-certified plastic surgeons before you proceed. The present plan is not "wrong" per se, but I think it is not very well thought-out, and I agree with Dr. Grzeskiewicz's assessment and hesitancy. I don't think he is being overly "forceful" at all, and would even amplify his concerns. They are well-founded, and you would be wise to heed them. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 118 reviews

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.