Transaxillary Incision for Silicone Breast Implants?
Doctor Answers 6
Absolutely! Transaxillary approach with highly cohesive Natrelle 410 or Sientra implants is the only way to go!!!
Absolutely! Transaxillary Subfascial approach with highly cohesive Natrelle 410 or Sientra implants is the 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.
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