I have consulted several surgeons regarding my Breast implants I plan to receive in November. I was told by 2 that complete submuscular placement can be achieved via the transaxillary, so I had decided to go for it, using silicone, but then was told this approach can not be used with silicone, is this true?
Is Transaxillary Incision Possible for Silicone Breast Implants?
Doctor Answers (8)
Silicone Breast Implants are Possible with a Transaxillay Incision
This is a great question you ask. Contrary to the opinions posted above (and I rarely disagree with Dr. Wallach), it is completely possible to place silicone breast implants through an axillary incision. In fact, my opinion and experience is that it is preferable.100% of the silicone breast implants I put in are through the axillary approach.
In considering this question here are a few things to have in mind.
- Fewer than 10% of augmentations are performed via an axillary approach.
- Among the advantages of this approach is that there are no vissible scars on the breasts and the axillary scar is extremely inconspicous.
- All will agree a silicone implant requires a incision that is longer than that for a saline implant. A question for any patient to consider is where they would prefer the scar; under their breast, around the areola, or concealed in the armpit. I would suggest asking the surgeon to see photo's of results and scars. You will be able to judge for yourself.
- Some have suggested that the transaxillary approach is not a good choice because they can not do secondary surgeries by this method. This is not the case. Surgeons who are experienced with this method can perform secondary procedures (such as exchanges and capsulotomies) through exactly the same incision.
- Some surgeons may feel it is too challenging to place a gel implant this way. Not all surgeons are comfortable with every approach. In the end it should be the patient's choice which approach to use but you certainly don't want to ask your surgeon to do something they are not comfortable with.
To answe your question, Yes, Transaxillary Incision is Possible for Silicone Breast Implants.
I hope you find this helpful.
Bernard Shuster, MD
Silicone Transaxillary Breast Augmentation
Submuscular gels via transaxillary especially with the Funnel
Gels can most definitely be placed via the transaxillary approach. Salines are definitely easier to place due to the smaller incision required and a little less dissection under the muscle tails where the implants have to make "the turn." I have been doing this technique since 1987 and have done around 2500 pairs. Other than during the "dark days" from 1992-2005, most have been gels. I used to have a limit of 425 for gels, but with the Keller Funnel I have placed 700's with some room to spare. The incision is longer but has not been a problem to date.
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Transaxillary Breast Augmentation with Cohesive Silicone Implants can be a wonderful choice
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.
Silicone and transaxillary appraoch
Silicone implants require a larger incision than saline and therefore may leave an unfavorably long scar in the axilla.
Transaxillary silicone gel implants some technical considerations
I agree with your other consultants that transaxillary silicone gel implants are difficult to seat because of the limited incision length. In those patients who are adamant that they must have a "scarless" breast augmentation, I will explain the technical consideration of size, style and texture, which makes the approach more challenging. The endoscope is used to more precisely develop the dual plane pocket but is removed prior to placing the implant, which is limited in its size, lower profile and smooth surfaces.
In my experience, this is a "teaser" fare which can only be used in the first instance. In the event of implant malposition or capsular contracture, another approach must be employed. The scars aren't exceptional and the time for implant settling is generally longer than one of the more direct approaches. Hope this helps.
Transaxillary incision not usually used for silicone breast implants
Silicone gel breast implants come completely filled and sealed, so they generally don't fit through the narrow pocket used in trans-axillary breast augmentation. If you go really small it might be possible, but I wouldn't recommend it.
Transaxillary breast augmentation
It is generally not recommended to have silicone implants placed through the transaxillary route. You have a choice, if you wish to have the incision placed in the axilla, then go with a saline implant. Otherwise choose a periareolar or inframammary incision for the placement of a silicone implant.