What are the pros and cons of through the arm pit sub muscular implant procedure?

Thank you for your question.  In my experience, many women prefer the transaxillary approach to breast augmentation as it leaves absolutely no scar on the breast.  The scar is very well hidden under the arm pit and is virtually undetectable after a 3-6 months.  Plastic surgeons who are experienced with this approach have no more problem with asymmetry than with any other approach. As with any technique, experience of the plastic surgeon is paramount.  I use the transaxillary approach with saline, silicone gel and Ideal implants with excellent results. In fact, one of the advantages of trans-axillary saline implants, is the lowest rate of capsular contracture.I have done both trans-axillary and infra-mammary breast augmentation for over 30 years and have not seen any more problems with asymmetry or malposition with the trans-axillary approach than the infra-mammary approach. Most surgeons have a preferred technique, often based on their training and clinical experience. When done properly, both of these approaches are safe and will provide a nice result. The infra-mammary approach is more common, but not necessarily a better option for you.  I hope this is helpful. Good luck to you.

Hi Elli. Thank you for your Question.Although many surgeons prefer the inframammary incision, current literature on incisions shows that the complication rates is the same among both transaxillary and inframammary incisions.The best incision should minimize scarring, allow safe pocket creation and safe implant insertion.The incision site is a decision that should be based on your preference along with your surgeon’s skillset in the particular incision. Your surgeon may recommend one incision over another depending on the incision’s ability to allow appropriate insertion of the implant while controlling surgical variables and reducing contamination and bleeding.With regards to the transaxillary incision, it is best for patients who have concerns for scars, who have sufficient breast tissue and normal breast shape, and who have a small areola (dark region around the nipple), or requires a small silicone or saline implant.Pros of the transaxillary (Arm pit) incision:No scars will exist on the breastThere is less trauma to surrounding breast tissues while dissecting an implant pocketIt allows surgeons to achieve hemostasis (blood-less dissection) thereby preventing hematoma where blood accumulates in the tissuesGiven optimal skill sets, you can place all types’ implants precisely into the surgical pocket.Cons of the transaxillary (arm pit) incision:If reoperations are required, an additional incision using the inframammary or periareolar approach is required to optimize control and accuracyThe axillary approach is not good for patients with tuberous breasts, constricted breasts, or with severe sagging.This approach can have an increased risk for implant malposition in the upper pole of the breast because of poor visualization of the inframammary fold.Great caution is required to prevent trauma to lymphatic vessels which are part of our immune systemYou can only do behind the muscle implant placement In many aspects, the inframammary approach surpasses the other incision locations and is best suited for patients who have a small areola (dark pigmented skin around the nipple), patients with breast sagging, and those who require large volume implants or form-stable implants. Compared to the under the armpit incision, the inframammary incision (under the breast) allows direct vision, less trauma to breast tissue, easier and precise pocket dissection, and undamaged insertion of the implants.Bottomline: Incision site depends on your scar preference, your implant size, and surgeon’s preferenceIt would be best to consult with a board-certified plastic surgeon.Hope this helps.

Transaxillary (armpit) incision offers the advantage of a less noticeable scar than fold or incisions around the areola. However, large silicone implants cannot be placed this way and the dissection through this approach can sometimes lead to the implants falling out toward the armpit.  It is not my preferred approach.  

Hello,Bottom line: There is very good data in our plastic surgery literature that shows the inframammary incision is the best in terms of lowest complication rate, next the trans-axillary, and then finally the periareolar incision. World wide, the inframammary incision is most popular. In Southern California, the periareolar incision is most popular, despite its high rate of complications.  If you choose trans-axillary, be sure your surgeon uses an endoscope and electro-cautery; there should be no blind or blunt dissection. Additionally, a Keller funnel needs to be used as well. Best of luck!

I believe there are really no cons to performing breast augmentation through an armpit incision by an experienced surgeon using an endoscopic approach.  However, some surgeons do perform breast augmentation with this incision, using a blind and blunt approach.  I feel this increases the risk of contracture and malposition of the implant.  Using an endoscopic approach, I believe you have the same degree of control and precision as other approaches for implant placement.  This does take additional training, specialized equipment and experience to perform properly.Aloha,Shim Ching, MD

PROs and CONS of through the arm pit submuscular implants breast augmentation:PROs :Incision is not present in the breastIncision "hidden" inside the arm pitAllows to place any  sice saline implantSometimes it allows to CONS:Usually limited to saline implantsLarge silicone implants can't usually be placedIncreased risk of assytry (since it is difficult to control the pocket for the implant)If incision doesnt heal well, it is very noticeable when lifting the arm and wearing sleeveless shirts

There are three incision access points for a breast implant - under the breast (inframammary fold), around the nipple (periareolar) or through the armpit (transaxillary).  Out of all the three, the inframammary approach has the lowest complication rates associated with it based on nationwide data.  The transaxillary approach has the highest complication rates, and in the opinion of most plastic surgeons who perform aesthetic breast surgery, should not be used at all.  It is not worth the scar on the armpit if you have a higher chance of developing scar tissue around the implant, nerve sensation issues, and implant malposition.  I hope this helps.

We have over 30 years experience with transaxillary breast augmentation.  I like this approach for saline devices because it can be accomplished in a concealed incision less than an inch long.  The use of an endoscope keeps the procedure controlled with little or no bleeding and precise pocket dissection.  This procedure does not lend itself well to the use of large silicone devices or shaped implants because of the potential damage to the implant unless the incision and tunnel are greatly enlarged at which point the advantage of this procedure is lost.  Transaxillary has been criticized by some because of imprecision but the endoscope is a critical ingredient in our opinion.

Breast augmentation is one of the most successful and satisfying procedures that we offer as plastic surgeons.  There are a number of factors that go into deciding upon the surgical approach and planning of the incision, but ultimately that is not the most important decision.  You can get excellent results through any incision, depending on what your body habitus is and what your cosmetic goals are.  With the "form stable" "gummy bear implants," an incision beneath the breast can be kept small and allows for optimal exposure of the pocket necessary to place and correctly position the implant, especially if the implant is anything but a simple round implant.  (If the implant is anything but a simply round implant, we as surgeons need to make sure the implant is not rotated clockwise or anti clockwise during placement, and we need to make sure the implant pocket is precisely dissected so that the position and orientation of the implant does not change with time.)  Other than that, the incision really just comes down to personal preference.  If you like to dance with your arms up and are wearing a sleeveless dress, the armpit incision is going to show.  Generally, unless you are in a very intimate situation or are planning to be completely naked (I take care of some exotic dancers), incisions under the areola or breast itself are not going to show at all, and they are extremely well tolerated and give wonderful results.

are nice for scarring as you have nothing on your breast... but its very common to have an incision on your breasts for subsequent procedures.  If you want the armpit approach, endoscopic surgeons have much more precision than the others.  But there has been studies showing increased risks for contractures through the armpit so make sure your surgeon uses Keller funnels for inserting your implant.  The breast approaches are easier and doesn't require a learning curve to achieve good results.  Contractures are the enemy and since its greatest through the armpit, I just won't do it, especially when the breast approaches produce more than good results.