425cc Mentor Silicone High Profile? Transaxillary Incision Preferred; Second Choice is Periareolar. Opinions? (photo)

34 y/o, small frame 116lbs, 64", fit; fitness bodybuilding 5d/week. Obviously my workout schedule will be altered. After trying on new Mentor kit forms, I chose 425cc however liked 400cc also... they fit more like moderate profile. When trying on Mentor silicone implant in bra alone, I settled on this 425cc/400cc size. I preferred transaxial incision however less encouraged by my physician due to implant size. I hv small areolas bilat. and little demarc. I did not want inframammary scar.

Doctor Answers 9

Breast scars and implants

Which scar is best for you with a breast augmentation? Definitely, the type of implant that is used will influence the choice made. A silicone implant comes prefilled and does require an incision length of 5cm to safely place the implant in the breast without traumatizing the implant too much. Therefore, the manufacturers recommend the inframammary scar approach. Most women do not have an areolar width that will permit a 5cm incision. With the size of implant you are considering the Keller funnel could be used and the periareolar incision feasible looking at you photos. The transaxillary scar can be noticeable if one wears a bikini or halter top if one lifts your arm overhead. So, the advantages of not having a scar directly on the breast can be lost. Also, one needs to consider the experience of the surgeon with the type of incision you prefer. Lastly, one should not compromise on the shape and size of the breast in place of the resultant scar. If done appropriately a well place scar can be very unnoticeable.

Austin Plastic Surgeon
4.5 out of 5 stars 19 reviews

Implant question incision choices

I love the trans axillary incision and have used it for over 10 years. It is hard to put silicone through a small arm pit incision but the Keller funnel is a game changer. Periareolar is also a great choice and heals with a scar that is usually great. The axillary procedure in my opinion is best done with an endoscope which not all doctors use. Trust your doctor and he/she will reccomend the procedure that they think in their hands will give you the best result.

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 60 reviews

Different doctors like different approaches

Over my 30+ years of doing this operation, I have settled on circumareolar incisions as the best, least obvious scars with the nicest placement. Trans ax almost always leaves the implants too high. No matter how good and careful the doctor is.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Transaxillary vs periareolar incision for breast augmentation

The debate regarding the advantages  or disadvantages of Transaxillary vs periareolar incisions involves several issues: many surgeons claim that the Transaxillary approach avoids any scar on your breast, however, if you are in a bathing suit or sleeveless workout clothing, that scar may make you selfconscious if it darkens or widens.  The periareolar incision may be an option for you if your surgeon can use a Keller breast funnel to put the implant in through a small incision.  Discuss this with him/her.

Leonard T. Yu, MD
Maui Plastic Surgeon
4.3 out of 5 stars 27 reviews

Transaxillary Augs Preferred

Dear StudentClinician.  Thank you for your question. My preferred entry site for implants has always been the transaxillary endoscopic-assisted approach (for either submuscular or subglandular/subfascial implants).  The problem with putting in large silicone implants through the underarm is that the size of the scar can get to be long.  If the scar extends beyond the hair-bearing patch, it doesn't tend to do as well.  I have comfortably put 375cc gels through the underarm and in certain women would consider 400-425cc, but that would depend on the underarm anatomy.  I have more info on my website if you would like to learn more.  Hope this helps!

Victor Ferrari, MD, FACS
Charlotte Plastic Surgeon
5.0 out of 5 stars 36 reviews

Trans axillary incision for breast augmentation

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
4.8 out of 5 stars 120 reviews

Peri-areolar vs transaxillary

Both are reasonable approaches and have advantages and disadvantages. In the transaxillary approach there is less than ideal visualization, which makes it difficult to control bleeding if that occurs. Peri-arealr could also work for you with that implant size. Have you considered the mamary fold? It is very well concelaed and I have never had anytone complain of that scar being a problem.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.3 out of 5 stars 35 reviews

Endoscopic Transaxillary Breast Augmentation

I prefer the axillary incision but only if it done with an endoscope. As was mentioned in another answer the Keller Funnel has been a game changer.  It is important that your PS use an endoscope to assure proper implant position.  Given the amount of breast tissue you have there will be little difference between those two implants. The difference is less than a shot of tequila. 


You have great breasts to start out with you will get a great result.

DR. Kearney

Robert Kearney, MD, FACS
La Jolla Plastic Surgeon
5.0 out of 5 stars 32 reviews

Transax vs other approaches for breast augmentation

I am not a big fan of transaxillary incisions for breast augmentation. I think the other incisions offer better exposure to make the pocket for the implant. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 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.