Transaxillary Pros and Cons?

Question

I'm 5'3'' weighing 98 lbs. I'm very petite with a small frame. I wanted much larger breasts and was hoping for silicone implants at 450cc to 475cc. Would such a large implant be able to be inserted through the armpit? I've read that if the implant is too large, it wouldn't be a good incision location. Also, would the shape be affected through the armpit? Which incision location is best for optimal implant placement? Thanks!

Jed H. Horowitz, MD, FACS · Answer

Transaxillary Breast Augmentation: Great OptionWe have been using this approach for over twenty years.This is our most common and recommended site for silicone implant placement. Axillary – with this incision, there are no scars on the breasts Special training, experience, and equipment may be required for this procedure.Potential problems noted by other surgeons are only by inexperienced doctors or are noted by those who have no experience with this technique

Gregory Turowski, MD, PhD, FACS · Answer

I think a lot of surgeons are against transaxillary breast augmentation because they do not feel comfortable performing it or they even never tried or got train in performing it. I learned how to safely and successfully perform this type of breast augmentation over 25 years ago. Since then I augmented many thousands of breasts this way and this is my experience: it is my preferred way to do it (for a right candidate) my main reason is: why mutilate perfect beautiful woman's body if you can avoid it? And there is really no downside, it is not true that are more complications, problems or capsular contractures than with any other way to do it. If surgeon is skilled and knows how to perform axillary breast augmentation results are very predictable. I would not be repeating this procedure for over 25 years if it would be causing problems. It would be insane since I sometimes have 10 patients /week and would ha to deal with a lot of unhappy women... And do not trust surgeons who tell you under the breast incision is great. Frequently, they are quite visible, stretched, dark, keloidal and quite annoying. Especially in small breasts that have no folds make these scars impossible to hide. Last time I performed inframammary incision is over 20 years ago. There is no need for that. Armpit incisions ALWAYS heal great, and they are either invisible or look like a wrinkle in your armpit. And in my experience problems that people are describing are if anything less common that with other approaches.

Sheila S. Nazarian, MD · Answer

As you can see from my colleagues comments below, the only real pro is that the scar is less visible, but, in my opinion, the cons well outweigh that pro, but speak with your surgeon as to his or her advise on the best approach for you. Best, Dr. Nazarian

Ronald J. Edelson, MD · Answer

The transracial art approach has a major drawback.  If you ever need further surgery done, it usually can't be fee through the armpit.  The supposed advantage of the scar is not as great as it sounds.

Thomas S. Taylor, FACS · Answer

In experienced hands and depending on the look of your natural breasts a transaxillary approach to your implant placement is a good option and will provide a good result.  There is one advantage to this approach: -no scars on your breastsThere are several disadvantages though:-more painful and longer recovery process-very difficult to do with larger silicone implants-higher chance of asymmetric implant position-if scar does not heal well it can be very obvious at the gym, in bathing suits, tank tops or anytime your armpits are exposed-you may end up with a second scar someday if you need another surgery. Secondary breast surgeries can't always be done through the initial transaxillary incisionAdvantages to a periareolar or a crease incision:-less pain and faster recovery-can use to place any type or size of implant-more predictable symmetry-the scar is always reusable in the future-easier to create tight cleavageThe only disadvantage to these incisions is you will have a tiny scar on your breast which generally heal very well.  Again, all these incisions can lead to great results. A lot depends on the experience of your surgeon, your anatomy and the breasts you are starting out with.  I hope this helps!Thomas Taylor, MD, FACSPasadena, CA

Gerald Minniti, MD, FACS · Answer

Hello,Round and smooth silicone gel implants in the size range you're interested in can be reliably and properly placed via an axillary incision. The goal of any surgery is to achieve the goals with as little trauma as possible. I use a lighted endoscope to perform meticulous dissection of the subpectoral pocket. However, no matter how delicate I perform this surgery, it still requires more cutting of tissue than when an inframammary incision is used.  Knowing that recovery will be slightly less comfortable, you may be s great candidate for this procedure!Best of luck!

Keith Hodge, MD · Answer

Silicone implants are pre-filled unlike saline. So, I think an implant that large needs to be placed through an inframammary fold approach. More importantly, based on your petite frame, the implants that you are considering are way too large. Please see a board certified plastic surgeon for an in person exam. Good luck!

Dan Mills, MD · Answer

while 450-475 is on the larger side of implants I have placed transaxillary it is easily doable even without a keller funnel, which would allow placement the easiest. I would not let the size deter you from a transaxillary incision.

Reza Momeni, MD, FACS · Answer

The size is not the major concern as it can be done, but the major risk of the technique is possible asymmetry if the surgeon is not experienced at this approach.   Be sure to discuss with your own surgeon about how this applies to you, and whether they have any special concerns in your case.

Curtis Wong, MD · Answer

and contractures are the enemy of augmentation as it will distort your breasts and require more surgery to repair.  Often, the transaxillary incision cannot be used again, depending on what the problem is and now you have a scar on your breast.  This is more than enough to convince me that though it can be done, why use it?

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