Armpit Incision for Breast Augmentation Because Nipples Are Small?

You will have scars for the rest of your life whatever your choice of incision. You need to decide where you want your scars based on your favorite activities and clothing. You do not want armpit scars if your hobby is ballroom dancing. You may not wish prominent breast scars if you like going topless.

I do a great number of transaxillary (armpit) breast augmentations and do not agree that the final shape is any different than an augmentation through a breast incision.

Placement of a 350cc silicone gel implant through an armpit is very straightforward and will not produce a longer scar than the one needed to go through an inframammary approach.

Transaxillary (armpit) endoscopic (surgical camera) breast augmentation can be performed for either saline or silicone implants.  Although the scar needs to be larger to place a silicone instead of a saline implant in the pocket, it can be done.  If your nipple areolar complex diameter is very small, it is impossible to place a silicone implant via the periareolar (nipple) incision.  If this armpit approach is performed using a surgical camera, it is the most modern, sophisticated way to create the space, shaping the breast under direct vision.  There is very little bleeding and bruising because all of the blood vessels are visualized and the bleeding is stopped before it even starts.  The pocket shape is very precisely created, resulting in fewer revision surgeries for implant malposition. The incision is hidden in an existing crease in the armpit, and behind the muscle.  The scars are very well hidden, as opposed to the inframammary fold (chest wall) incision, which can either ride up on the breast, or be place too low and show on the chest wall below the bikini. It is a very specialized approach which requires extra equipment and extra experience from the surgeon.  Make sure that the board certified plastic surgeon has enough experience with transaxillary endoscopic breast augmentation.  

Trans-axillary breast
augmentation is becoming an increasing popular method for breast augmentation as
technology continues to improve. There are several misconceptions about
axillary breast augmentation.

First of all both saline and silicone implants
can be used with this method. Many patients and surgeons that do not commonly
perform this surgery don’t know that a silicone implant can be placed from an
axillary incision. The use of the Keller funnel allows a variety of
implants to be placed through the axilla easily.

Secondly, the incisions in the axilla is just as
small as it would be if it was placed around the nipple or under the breast.
The incision is well concealed in one of the natural arm creases in the axilla.




Thirdly the use of the
endoscope has made the procedure very precise as the entire breast pocket is
created under direct vision. This method has become very popular in Miami where
I first practiced and now I commonly perform this procedure here in Austin
Texas as it avoids putting any incisions on the breast, thus decreasing the
chances of altering nipple sensation.

Please consult your board certified plastic
surgeon to help guide you through your breast augmentation process.

Armpit incision is a wonderful scar-free option for breast augmentation. Silicone implants can absolutely be inserted through the arm-pit, don't let anyone tell you that is not an option. There are few reasons for an incision under the breast or through the nipple. 

Thank you for question. Your situation is somewhat applicable to any prospective patient with very small nipples. The issue in breast augmentation with using the periareolar incision for a patient with small nipples is that the incision itself just can't be very large. To comfortably get a 350cc implant into the breast, you need a 4cm incision. The transaxillary incision would be fine, but yes, the incision would be visible when you raise your arms. In addition, the surgeon has less control of the lower pole of the breast in terms of making the pocket for the breast implant and positioning it relative to the inframammary fold. I tend to prefer inframammary fold incision. It hides in the crease of breast, making it almost invisible, and it doesn't depend on the nipple at all. In addition, I have good control of the breast implant and the pocket as I insert the implant during surgery. Good luck with your surgery!

Implants can be inserted through the belly button, the armpit, the nipple/ areola and through the inframammary crease (the fold below the breast). The location of the scar should be based on several factors. The first consideration is the safety of the technique. The belly button approach is known to have a high risk of complications. Because of this, the American Society of Plastic Surgeons does not even recognize it as a valid approach for breast augmentation. Another consideration is whether the approach can yield consistently good results. The armpit approach makes it very difficult to control the shape of the breast consistently. The reason is that working through the armpit prevents the surgeon from properly visualizing all aspects of the inside of the breast. Thus, a lot of the shaping of the breast has to be done blindly. Therefore, the results can be unpredictable. The surgeon may have a great result one time, and a poor result the next time. One must also consider the potential side effects and complications from each approach. There have been many studies which show that inserting implants through the nipple/ areola can increase the risk of capsular contracture. Capsular contracture is a condition in which the scar tissue around the implant becomes very tight and hard. This causes the implant to be squeezed and the breast appearance to become deformed. The theory is that making the incision around the nipple and areola cuts into milk ducts which have bacteria in it. The bacteria then get transferred to the implant as it is inserted. Although only a few bacteria get on the implant, it is enough to cause inflammation around the implant which then leads to capsular contracture. Another possible side effect/ complication of inserting implants through a nipple/areola approach is the risk of numbness and/or inability to breast feed. Although these risks exist with any surgery on the breast, it may be slightly higher with the nipple/areolar approach. The last consideration should be the cosmetic appearance of the scar. The nipple/areola scar heals very well. The scar is made in the border between the dark color of the areola and the lighter color of the breast skin. This camouflages the scar very well. However, it is important to understand that all scars, no matter how perfectly they are designed and heal, are always visible. Therefore, the scar on the nipple/ areola will always be slightly visible when the breasts are not covered. The scar in the inframammary fold is designed to fall in the crease that will be formed once the implants are inserted and have time to "drop" to their final position. Even women who do not have a fold or crease to begin with will have a fold or crease after augmentation. Therefore, this scar heals in a location that is never visible, even when nude, unless the woman lifts her breasts. Furthermore, the scar heals very well in this location and eventually becomes a very fine line. For all of these reasons, the inframammary fold is the preferred method of inserting implants for top surgeons. Using the inframammary fold allows for more control over the breast shape, which leads to better and more predictably consistent results, with the least amount of risk and the best chance for a barely noticeable scar.