Transax incision or Inframammary? MIXED ANSWERS DURING MY CONSULTS- Can't decide.

It's literally a 50/50 consensus after going through several consults and I really don't know which to choose anymore. I'm 5'1''-5'2'' at 96-96 lbs. and all the surgeons have said I have symmetrical breasts, great shape and distance so, which should I opt for? My main concern is that I don't want a visible scar on my breast so, I'm naturally pushing for the transax but, the inframam seems to be more common with less complications. I'd like more opinions on this- which is "better"?

Doctor Answers 36

Incision Decision

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It is true, that inframammary incisions are the most common in the world, and statistically contribute to lower complications, especially capsular contracture, the most common complications associated with re-operation. My second preference would be transaxillary, but only under endoscopic guidance so that rapid recovery principles of all electrocautery dissection can be maintained. 

Truth be told, the least traumatic and most direct way of breast augmentation is via an inframammary incision. It has somehow gotten a bad name here in Southern California where the periareolar incision reigns king (queen), but in fact heals extremely well and is virtually invisible with time (one to two years) in most people. 

Best of luck!

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Transaxiallary Incision or Inframammary?

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Well you have pretty much summed it up. The transaxillary incision appeals to many patients because it takes the scar off the breast and places it in the axilla or arm pit. This does not make it invisible, in fact, it now becomes more visible to the general public in that location. But this comes at the price of a higher risk of capsular contracture because the implant is being dragged through the sweat glands in the axilla which harbor many bacteria, and a higher risk of implant malposition because the pocket dissection is less precise. Depending on how the surgery is performed there can also be a higher risk of bleeding. That's not to say that you will necessarily have one of those complications, but if you do, having the incision in the axilla would not be worth it, and you would likely end up with an inframammary incision if there is a problem.

Yes, the inframammary incision is more common and the complication risks are lower. When properly done, in most patients the inframammary incision should be virtually invisible as it heals over time. Also if you have an usual breast shape or position the inframammary approach allows for more modification of the tissues to achieve an optimal result.There is not a "better" approach. It is a matter of deciding what is most important to you


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one deciding factor would be do the surgeons use the endoscope.
no scope, no axilla. a blind surgery is not a good surgery.
with a scope i think they are equivalent, just 2 different accesses to the same surgery
i prefer the areolar approach because the contrast of color between the areola and the breast skin distracts the eye from recognizing the scar.
i avoid the infra-mammary approach because with the arms up or lying down the scar is right there when you probably don't want to have it seen
also the scar outcome has a lot to do with your post-op behavior
don't traumatize it, keep it protected and avoid all garments that will rub on it and it should be almost invisible regardless of the approach.
good luck

David Rosenstein, MD
Boynton Beach Plastic Surgeon
5.0 out of 5 stars 17 reviews

Transax incision or Inframammary? MIXED ANSWERS DURING MY CONSULTS- Can't decide.

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The preferable technique is dual plane placement of the implant to get the most natural result with the least animation deformity when using the chest muscles. That cannot be done properly through the axilla so you need to choose between small scar and best results or hidden scar and probably not as good a result. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Choice of incision

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The reason there are so many answers is that each surgeon has a slightly different experience as far as the best result in their hands. In this country approximately 70-80% of board certified plastic surgeons use the inframammary incision because it provides the best exposure for the placement of the implant. Also, if and when revisions need to be done the same incision can be used at a later time instead of having another incision on your breast. In my practice 100% of my breast augmentation patients undergo the inframammary incision. In my hands, this gives my patients the nicest results. None of my patients have ever been disappointed with the appearance of the scar.Ultimately, if you trust your surgeon and they have performed numerous procedures with a particular technique then you will likely have a nice result.

Best wishes,
Dr. Ravi Somayazula

Ravi Somayazula, DO
Houston Plastic Surgeon
4.8 out of 5 stars 71 reviews

Trans-ax approach

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Trans ax approach with silicone implants requires a wide tunnel dissection which can injury the intercostalbrachial or the medial brachial nerve giving you numbness of your arm; as well nationally, this approach is associated with asymmetry following surgery. Don't make a surgery more complicated than it needs to be, the IMF is the ideal choice.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 108 reviews

Transaxillary vs Others

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Transaxillary approach although appealing, does have its drawbacks.  It has been show to have a higher chance of malposition of the implants.  Pocket control is more difficult as the dissection is performed bluntly.  That is the main reason most plastic surgeons will not perform it.  One of the plastic surgeons I was trained by did entirely transaxillary breast augmentations and today I opt to not perform this procedure for my patients because of the malposition and reoperation rate.  This also goes for TUBA procedure as well. 

Periareolar or inframammary incisions if placed in the appropriate position will heal exceptionally well and be hidden.

The chance of having the best breast augmentation result is at the time of the first surgery.  Keep that in mind.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

Trans ax or not?

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Hi Blondedonut, Your main concern is to not have a scar on you breast. Unfortunately the armpit has some pesky downsides. It is an area where there is a higher bacterial count on the skin that even the best skin prep can't completely eliminate. This can result in a frank implant infection (necessitating a likely removal) Statistically a non armpit incision has a much lower infection rate. The second downside is a subclinical infection of your implant that can result in a biofilm that causes a capsular contracture.
So ask yourself is the scar in your armpit worth the very real risk of an adverse outcome?What will help you decide? If you are a nudist, or an actress who does nude shoots then the scar issue is real, for almost everybody else the other alternatives are excellent choices

Max Gouverne, MD
Corpus Christi Plastic Surgeon
4.7 out of 5 stars 36 reviews

Transax incision or Inframammary? MIXED ANSWERS DURING MY CONSULTS- Can't decide.

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Complications such as asymmetry and too large pocket with implants falling to side are more common with transaxillary breast augmentation. The inframammary incision is safer. properly done it is invisible after breast drops over the scar. If you choose transaxillary find a plastic surgeon who does the procedure through an endoscope

Transaxillary vs infra-mammary

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Hello and thank you for the question. This is a common issue amongst plastic surgeons today. I would guess that most plastic surgeons prefer the infra-mammary  approach.  I understand that this scar is somewhat undesirable however it falls within the natural crease that is under the breast and in most cases is hard to see after it has healed. The axillary approach has a benefit of no scar on the breast but there can be a visible scar in the armpit especially if you wear a dress or shirt that does not have sleeves. In some patients especially Hispanic and Asian patients that scar can sometimes become hyperpigmented in my experience.If that is the approach you wish to take make sure you seek a board-certified plastic surgeon who specializes in the axillary approach. Most of the time the axillary approach is done with saline implants as it is easier to place a saline implant through that type of incision then already filled silicone implant however I'm sure there are some who can do both with equal ease.My personal preference is to use the infirmary incision I find that is the best incision  for both saline and silicone implants and in my experience has the lowest complication rate such as malposition and capsular contracture. As always best to seek several  consultations before making a decision. Be healthy no smoking and if you have any health problems make sure that they are managed by your primary care physicianBest to you.

Bennett Yang, MD
Rockville Plastic Surgeon
4.8 out of 5 stars 21 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.