Can Breast Augmentation with Silicone Cohesive Teardrop Implant Be Done with Transaxillary Incision?

Can Breast Augmentation with Silicone Cohesive Teardrop Implant Be Done with Transaxillary Incision?

Doctor Answers 14

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

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.  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.  


I hope this helps,


All the best,


Rian A. Maercks M.D.


Can a gel implant be placed through a trans-axillary incision.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Technically this could be done, but I think it is a bad idea.  In my experience, the transaxillary approach is riskier for infection and, to be done correctly, must use a very small incision and an endoscope to create a small tunnel.  If not, the implant always works its way into the axilla when the patient is lying down.  I think it can be done with a saline implant, because the implant is inserted in the deflated state through a very small tunnel.  However, gel implants are already filled.  By definition, the tunnel was big enough for the implant to go in, so it will always work back toward that direction.  A form-stable implant compounds this problem.


Dustin L. Reid, MD
Austin Plastic Surgeon
5.0 out of 5 stars 86 reviews

Transaxillary "gummy bear" Breast Augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I have performed thousands of transaxillary augmentations over the last 27 years and have been involved in discussions involving the tear drop cohesive gel ("gummy bear" / 410) implant as a member of Allergan's Novo breast aesthetic council. With that said, I would never attempt to place one of these implants via the transaxillary route. Besides obvious physical challenges of insertion, the pocket must be a perfect fit for the implant and not over-dissected to avoid rotation. This is difficult enough with the incision in the breast crease and impossible through the underarm regardless of the level of experience. Stick with proerly placed standard "round" gel implant and you should end up with a teardrop shaped breast.

Lawrence W. Shaw, MD
Arizona Plastic Surgeon
4.9 out of 5 stars 77 reviews

Transaxillary Incision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I use the transaxillary, submuscular approach in nearly 95% of my primary breast augmentations because it hides the scar so well. The overwhelming majority of my patients choose silicone implants because of a more natural look and feel when compared to a saline implant. Yes, it is true that the incision for a silicone implant insertion will be longer than one for a saline implant insertion, but that is true for ALL approaches (including periariolar and inframammary incisions). For an average size implant (350cc) the incision length is usually only one-half inch longer than it would be for a saline implant insertion. That length of scar in the armpit (about 2 inches long) still hides extremely well. When using the Keller funnel. I have placed implants as large as 550cc in a primary augmentation without difficulty. If you choose the transaxillary approach, make sure your surgeon is experienced in this method.

Robert M. Kachenmeister, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 28 reviews

Is Trans-axillary Incision Possible with Silicone Gel Breast Implants?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
This is a great question as there is a common misconception that only saline implants can be used for trans-axillary breast augmentations. The vast majority of the time I use silicone implants for my axillary breast augmentations.

I have placed implants as large as 700cc in through the axilla with the use of the Keller funnel. The funnel allows the implant to go in though the axilla easily and smoothly. Patients should not limit what implant they would like to use because of the incision that they want for their breast augmentation.

Many patients that chose to have a axillary breast augmentation want it because it will conceal their scars and give them a very natural appearance. The use of silicone implants aids in giving patients the most natural appearance possible.

If you are interested in an axillary breast augmentation with silicone implants please see a board certified plastic surgeon with experience in the procedure as they will be able to help guide you!


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Most surgeons are unable to place silicone implants via the transaxillary incision. This is because silicone implants come pre filled, making it a more complicated procedure to insert and position the implants in the body accurately because of their size. However, I have experience performing this and the rate of satisfaction is high.

Trans axillary incision for breast implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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

Tranaxillary approach for tear drop shape form stable implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It would be a bad idea to place a form stable cohesive tear drop shaped silicone implant due to few facts. The implant is difficult to insert from that anatomical area since it is not compressive and would require a large incision. To place the implant properly and to avoid the rotation or "flipping" of the implant the pocket needs to be created in specific manner that is very technically challenging.

Smooth round implants work well what was the reason for using the stable form implant?


Best of luck

Almost anything CAN be done...

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

the real question is...should it be done?  The silcone cohesive teardrop implant is not currently available for general use in the U.S.  Technically, the operation can be done, and perhaps the use of a breast funnel, which I use on a regular basis for breast augmentation cases, will allow access with a reasonable sized incision.  The fact is that the implant is too new to get and its results, indications for its use and long term benefits have yet to be determined.  Good luck!

Breast implants via armpit

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Cohesive gel implants are still not approved for general use by the FDA.  While a transaxillary approach is one way to place implants, the size of the incision to accommodate a textured cohesive implant would be quite large.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.