Can a pocket adjustment be done using a transaxillary method? Concerned about scarring (photo)

Question

I have double bubble on one side and obvious bottoming out on the other. A virtual consult with a different surgeon said that the og surgeon should not have put this size in my chest. The pocket was too big as well causing lateral displacement. I originally had transaxillary due to extreme phobia of scars. But this surgeon said I have to get an under boob scar. Is it possible to find a highly skilled surgeon that could fix the pocket and exchange for much smaller implant through armpit?

Wayne I. Yamahata, MD · Answer

It would be very challenging to treat your issues through a transaxillary approach. The outcome would be far less reliable than an inframammary approach. I suspect you will be hard pressed to find a surgeon willing to do this through the axilla.

Dallas Buchanan, MD · Answer

The short answer is no. A significant pocket repair cannot be done through a TA incision. In fact, pocket malposition problems like you have are most common with the TA approach and this is part of your original problem, so why rely on that method again to fix the problem. Do it right this time.
Good luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Daniel Barrett, MD · Answer

Dear Skylint,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Kenneth R. Francis, MD, FACS · Answer

Dear Skylint,
In discussing the pros and cons of all options for breast augmentation techniques with my patients two disadvantages of transaxillary breast augmentation are always mentioned: 1.  less precision in positioning of the breast implant (unless maybe with endoscopic), and 2.  the possibility that an inframammary incision might be required for future breast implant issues (displacement, capsular contracture, breast implant leakage, double bubble, bottoming out, etc).  It is easy for a second plastic surgeon to say that your original surgeon did this, or that, wrong, i.e. he/she put in a breast implant that was too large for you.  In fact, that is shameful, and likely a solicitation to now get your business.  Your implants do not look oversized.  Double bubbles, bottoming out and capsule stretching (not the pocket being made too large) can occur in the best of surgeries performed in the best of hands.  At any rate, revising your breast augmentation through an axillary incision at this point would be virtually impossible.  I would suggest 2 things.  Seek another opinion with yet another American Board of Plastic Surgery certified plastic surgeon, who, if ethical enough, may not be so eager to slander your original surgeon.  Then return to your original surgeon with your concerns and newly gained knowledge.  He/she should have a correction plan, and will likely give you steeply discounted fees, if any at all.  Good luck!

Connie Hiers, MD, FACS · Answer

No, the axillary incision is very limited and difficult to use for pocket repairs. Many times, a new incision is needed just to replace the implant.  This is not about "skill" but ability to visualize well and control the pocket well.

Richard P. Rand, MD, FACS (retired) · Answer

You cannot be accurately repaired through the armpit. A IM crease incision would be recommended by most.

Can a pocket adjustment be done using a transaxillary method? Concerned about scarring (photo)

Answers (6)

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