Opinions on Armpit Incision for Breast Implants Repair?

Recently, found out via digital mammogram that the left one Breast implant has ruptured extracapsularly toward my shoulder. I'm waiting for MRI results to see if the right one is also ruptured. I am having difficulty finding any cosmetic surgeon in Houston who will use the incision under my armpit to remove and replace the implants. I do not want visible scars. Any comment regarding my desire to go through the armpit incision for this second surgery?

Doctor Answers 10

You need to have an incision on or near the breast

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The armpit incision isn't good for dealing with complex breast implant revisions. In order to handle these situations properly, it is necessary to have visualization and exposure. These are not available through the armpit. The reason the surgeons in your area are resistant to your request is that it would not allow them to do the necessary work safely. The periareolar and crease scars are very acceptable after they heal to most patients.

Breast implant revision through armpits

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 The transaxillary approach is a very difficult approach to get good access to perform a breast revision surgery.    I would opt for a periareolar or inframammary incision to get better access and control of the problem.

Revision of Breast Augmentation through Armpit Incision

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Hi there-

Congratulations on having gotten 30 years of satisfaction with your initial implants!

I do not think that under any circumstances you should be in a hurry to have your current situation managed through the same incision however. Your needs at this point are much different- initially, you wanted larger breasts and to avoid visible scarring... At this point, the goal is to remove as much of the free silicone as possible while still achieving a pleasing breast shape.

Considering the need to remove free silicone, remove the existing scar capsule, and the implant shell, and the need to place and position new implants, there is no way I can imagine that I would be comfortable or feel responsible attempting to do this for you through your armpit scar.

The scar does not necessarily need to be conspicuous, but it does need to be in an alternate location to do the surgery you need.

Difficult to perform ruptured gel implant removal from transaxillary approach

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The advantage of a transaxillary incision for breast augmentation is that there are no incisions on the breast. The disadvantage of this incision is that if there is a complication it may not be treatable through this incision. With the existing equipment there is no way to technically perform a ruptured silicone gel implant removal and capsulectomy from this approach. Most plastic surgeons will use either the areolar incision or the inframammary crease incision.

Periareolar or inframammary incision

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You will probably need a capsulectomy as well as cleaning up the silicone. Pretty difficult to do a good job on your repair through the armpit.

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 45 reviews

Implant Revision

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You will unlikely find a good plastic surgeon that would do a revision through the arm pit incision. It is a very limited incision and not recommended if you want to place silicone implants again. It causes to much damage and strain on the shell. Besides you need all that silicone mess cleaned up and no done well through that incision.
You will likely hear most plastic surgeons tell you, you need a periareolar incision or inframammary incision. In fact, in patients that I offer the arm pit or transaxillary approach I tell them that if they ever need revision surgery that they will require another incision.

Armpit incision for breast implant revision

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As the other surgeons have stated, the armpit (axillary) incision does not give enough exposure to deal with revision surgery. There is also a higher incidence of capsular contracture as compared to the breast fold (inframammary) incision. 

This information  is for educational purposes only and is not a substitute for a consultation with a plastic surgeon certified by the American Board of Plastic Surgery.

Armpit incision for revision

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I do this all the time.  As many as 64% of revisions I do through the armpit especially if that is the first incision used.  Find someone who is very experienced in this incision and see them.
Dan Mills MD FACS

Dan Mills, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 33 reviews

Armpit incision not really good for breast implant redos

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Many plastic surgeons like myself shy away from the arm pit incision due to the fact that it can rarely be used for redos as well as positioning problems. If you want the procedure done correctly, then you will likely need to accept another incision for your re-operation.

John P. Di Saia, MD
Orange Plastic Surgeon

Breast implant revisions through armpit are difficult

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One of the reasons that the armpit incision isn't used as much as others is the near-impossibility of doing any reoperation through the same approach. While some procedures can be done, with rupture it just isn't a good idea.

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.