Slow Implant Settling Process for Transaxillary Approach?

I had silicone implants placed submuscular via the transaxillary approach. The disadvantage is that it will not give my PS dual plane access or the ability to do the dual plane (according to him), and it will tend to ride higher and settle slower than through the inframmary approach. Would this mean that I am at a disadvantage of having less natural results because I have full submuscular vs dual plane? I am one week post op, was a preop 32A, and my muscles are holding the implants high close to my collarbone.

Doctor Answers 5

Can a dual plane pocket be created during a trans-axillary breast augmentation?

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There are a lot of misconceptions about the axillary approach to breast augmentation.  In the past the augmentation was done “blindly” or with limited visualization of the breast pocket.  This lead to implants that were high or limited release of the inferior portion of the pectoralis muscle as is done in a dual plane breast augmentation. 

Trans-axillary breast augmentation is now performed with the use of an endoscope.  This special scope allows visualization of the entire breast pocket through the tiny incision in the axilla.  The scope displays the pocket on the high definition screen, similar to how a knee is scoped for professional athletes. 

The enhancement in the visualization of the pocket has made the axillary approach to breast augmentation very consistent and safe for patients.  The breast pocket can be created just as it would be via other approaches, with the surgeon able to create the pocket to meet the desires and needs of each individual patient.

Please consult with a board-certified plastic surgeon that performs a high volume of trans-axillary breast augmentation as they have the special equipment that is necessary to precisely perform your surgery.  

Transaxillary problems with implants

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The transaxillary approach is one option for the incision. One of the problems can be inadequate release of the muscle inferiorly leading to high implants. Give it some time, they may come down.

Breast implants do settle

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Smooth shelled breast implants definitely "settle". Submuscular breast implants almost always appear too high and tight in the early post-operative period. They almost always get lower as the muscle relaxes. This occurs regardless of the location of the incision. In my experience, the larger the implant, the more they tend to settle. Textured shelled implants are different. They settle much less.

Unfortunately, I don't think they will come down.

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Hello again, stomachsleeper!

We are all prone to wishful thinking, even plastic surgeons. So this notion has developed that implants will somehow "settle". I have done many hundreds of breast augmentations, and that is not my experience. Breasts need to look great and implants need to sit at the right level immediately after surgery. Otherwise, they probably will not later.

What I recommend is sitting the patient up before the end of the operation (you are still asleep, of course) to make sure the implant pockets are low enough. If they are too high, we keep working and look again.

It sounds like your implant pockets need to be lowered. This problem is much more common with the trans axillary approach. But, of course, I would wait several months before doing a revision, just in case you are the exception and your implants do come down some on their own.

You can get implants down to the right level using the subpectoral plane. The plane is not the problem; it's cutting the pocket down low enough.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Not a question of dual plane...

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All subpectoral muscle implants are dual plane as opposed to completely submuscular since the pectoralis muscle is triangular in shape and normally does not mirror the surface area of the breast tissue. The problem with the transaxillary apporach is that if the dissection is done in a usual blind and blunt manner the inferior release of the fascia and muscle may not be accurate nor complete as necessary to create an adequate pocket. The inability to release the muscle will cause the muscle to pull up on the implant and the implant will want to go toward the direction from which it came, namely, toward the axilla. Correction of this is difficult through the transaxillary approach unless done endoscopically and may require a second incision around the nipple or in the inframammary fold, thus defeating the primary reason for choosing the transaxillary incision.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

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