Breast Augmentation Under the Arm

considering getting a BA under the arm...woried about the incision causing damage to lymph nodes as well as swelling. do you recommend altenitives for incision than under the arm?

Doctor Answers 38

Trans-axillary Breast Augmentation, a Safe and Effective Method

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Trans-axillary breast augmentation is a very safe and effective way to have your breast augmentation performed.

First of all both saline and silicone implants can be used with this method. It is a myth that only saline can be used for your augmentation. I routinely place a wide range of silicone breast implants in through the axilla. The use of the Keller funnel allows the implants to be placed through the axilla easily.

Access to the breast pocket is actually more direct than with other methods. The muscle can be palpated in the axilla and the implant can be placed underneath this with out cutting any of the breast tissue. The implant is placed easily into a natural plane.

The use of the endoscope has made the procedure very precise as the entire breast pocket is created under direct vision. This had made the results very consistent and predictable.

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

Trans-axillary breast augmentation

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I have not heard of any damage to lymph nodes using the trans-axillary technique. Sounds like something someone would say who doesn't use this technique and is trying to scare you away from it. But if you go to a doctor that doesn't like to do the procedure one way or another it's better to do it the way he/ she likes to do it. I do breast augmentation all the different ways so if you are a good candidate it comes down to where you want the scar.

David E. Kim, MD
Beverly Hills Plastic Surgeon
4.6 out of 5 stars 106 reviews

Absolutely! Transaxillary approach with highly cohesive Natrelle 410 or Sientra implants is the only way to go!!!

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Absolutely! Transaxillary Subfascial approach with highly cohesive Natrelle 410 or Sientra implants is the way to go!!!
Absolutely! Transaxillary approach with highly cohesive Natrelle 410 or Sientra implants is the only 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.

Breast Augmentation Under the Arm??

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Hello! I highly recommend the inframammary crease incision versus the incision in the armpit. The reasons for this being that it is techincally easier to get a perfect result, it has a lower complication and infection rate, this incision can be used for revisions if needed, and silicone implants can be place through this incision.

Robert Heck, MD, FACS
Columbus Plastic Surgeon
4.9 out of 5 stars 83 reviews

Underarm incisions for a breast augmentation

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when performed properly, the incision in the armpit does not damage any lymph nodes or cause any more swelling than an incision elsewhere used for a breast augmentation.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Breast implants through the underarm

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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 123 reviews

Breast augmentation incision

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My usual recommendation is to make an incision in the crease under the breast. There is a full and safe anatomic view for the surgeon and better control of breast crease symmetry. There is also no worry about nicking the incision while shaving.

To my knowledge there are no lymph node dangers associated with the armpit incision but certain alternatives do exist. I would look into all of your options and speak to several surgeons before making your final decision.

Under Arm Incision for Breast Augmentation by an Experienced Surgeon

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The trans-axillary, or under-arm incision, for breast augmentation has been around for more than 30 years.  The initial problems surgeons experienced were improper placement of the scar and a blind dissection of the sub-muscular pocket for implant placement causing asymmetry and mal-position of the implants.  It is now been shown that placement of the incision within the hair-baring skin of the armpit heals with imperceptible scar.  At no timed during the operation do I encounter axillary lymph nodes and arm swelling is virtually non-existent. 

I personally pioneered the use of the endoscope to address the pocket problems and implant mal-position in the early 1990s.  Many experienced plastic surgeons now prefer the trans-axillary approach for primary breast augmentation.  Lymph node problems, scars, and implant mal-position are all issues of the distant past. 

Paul S. Howard, MD, FACS
Hoover Plastic Surgeon

Trans axillary breast augmentation

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Hello and thank you for the question.

If a trans axillary breast augmentation is performed by a qualified and experienced surgeon, the chances of having lymph node involvement are very rare. I perform most of the conventional approaches ( peri-areolar, infra-mammary crease, and trans-axillary) to breast augmentation. My preferred approach is the peri-areolar. In my hands, it produces the best scar and allows for superior exposure to the implant pocket. There is some data to suggest that this approach carries with it a slightly higher chance of developing a capsular contracture due to the violation of the breast ducts which occurs during the dissection. All 3 conventional approaches fall within the standard of care. To maximize chances of best results, I recommend you find a board certified plastic surgeon that is experienced in breast augmentation surgery.


Glenn Vallecillos, M.D., F.A.C.S.

Glenn Vallecillos, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 30 reviews

Transaxillary Breast Augmentation Done Endoscopically

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The transaxillary approach is a great option for most women.  The modern way of doing it uses endoscopy to dissect a precise pocket and in no way is this a "blind" procedure.  In fact, the view is magnified, and allows a great view to accomplish a meticulous dissection of the pocket.  For example, the view is better than a periareolar procedure, where dissection through the breast tissue itself creates a tunnel that limits exposure of the pocket.  The lymph nodes are in a completely different level of dissection, and I have never seen a problem with that.  Occasionally a woman will have temporary numbness on the undersurface of the arm from stretching of a sensory nerve to that area, but I have never seen this be permanent.  There are pros and cons to each approach.  Find a surgeon that does them all to give you an objective opinion on what is best for you.

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.