Healing time and limitations with the BA transaxillary incision verses the inframammary incision?

Question

I am considering a BA and trying to decide which incision is best for me. I am concerned about the pain; healing process; scaring; and being able to breastfeed when I decide to have kids. I want to be able to go back to work soon and start back with my regular activities (i.e exercise, running, etc.). As such, I'm wondering what is the healing time/process and what are the limitations with the transaxillary incision verses the inframammary incision.

Gregory Turowski, MD, PhD, FACS · Answer

I think the main issue with the site of incision is how predictable the scar is and how visible it is. Scars in the inframmary fold can be very acceptable but often are not. And despite popular belief it is quite exposed area -  naked women often are viewed from under the breast angle. Armpit incisions always heal well. I have performed thousands of these procedures and never encountered a bad scar. They are either invisible or look like a wrinkle. The main reason not to do it is the skill of the surgeon. Inframammary incision is the easiest to perform for the surgeons and axillary incision can be quite demanding. But scars are forever

Martin Jugenburg, MD · Answer

Hi there, Thank you for your question. Typically the healing time for these 2 routes are the same. In some cases with transax the implant sits a little higher initially vs the IMF route. It may take more time to settle.Best, realdrsix

Christopher V. Pelletiere, MD · Answer

When it comes to recovery time, the incision does not play a role.  However, the incision is very important to limit longer term complications.  All of the published data shows that the inframammary ( breast crease) Incision has the lowest complication rate long term, especially as it relates to scar tissue and implant position.  I recommend coming for a consultation to go over your options are really figure out what will work best for you.  I hope this helps.

David Shifrin, MD · Answer

Good question. Transaxillary is a nice approach in those who form ugly scars. The scar is hidden in the armpit. Most patients do very well with an inframammary incision that is well placed within the fold. There is some technique differences between surgeons and placement of the scar in the fold needs to be planned appropriately. Transaxillary augmentation is also done a few ways. I prefer to use an endoscope to visualize the complete surgery as opposed to a blind dissection. You will have to ask your surgeon what they use. In my practice, transaxillary augmentations take a little bit longer for their implants to fully drop as the pectoral muscle is lifted higher up on the chest wall which leads to more swelling. In any case, both are fine options for an augmentation in the correct hands. Visit with American board of plastic surgery certified surgeons for best results!Cheers

Dhaval M. Patel, MD · Answer

thank you for your question. They are both good options. Your recovery will be pretty much same along with postoperative limitations until you are fully healed. It's best to have a thorough in person consultation with a board-certified plastic surgeon in your area to discuss all of your treatment options. Best of luck!
Dr. Dhaval M.Patel
Double Board Certified Plastic Surgeon
Chicago-Water Tower Place, Oakbrook, Hoffman Estates, Orland Park

Peter E. Johnson, MD · Answer

We really like the transaxillary approach because it keeps the scar off the breast and can be important depending on skin type and scar history. Some surgeons find the technique more troublesome for them, however experience, right technique, and the Keller funnel make it work in our practice. Recovery is the same in terms of healing time and tenderness.

Jason M. Petrungaro, MD, FACS · Answer

Thank you for your message.  You have asked about transaxillary versus inframammary incisions for breast augmentation.  Let's address each of the points you mentioned.1. Pain -- should be essentially the same between the two (you will be sore, but the pain is very tolerable)2. Healing/recovery process -- again, really no difference. I allow full activity after 6 weeks.  3. Scars -- there will be a scar in each location.  Both are completely hidden even with your shirt off, so it really makes no difference.4. Breastfeeding -- neither incision will have any effect on your ability to breastfeed, and breastfeeding is safe after a breast augmentation with either saline or silicone implants5. Return to work/activity -- I allow my patients to return to work after 3-7 days after a breast augmentation, depending on their job.  If they have a desk job, they can go back to work sooner than if they are a manual laborer.  I ask that exercise stops for at least a week.  After that the patients can slowly start to ramp up activity.  Arms and chest will not be worked for a full 6-8 weeks.  There is no difference to this rule for the different types of incisions.The vast majority of breast augmentations are done via the IMF incision.  That is how I perform nearly 100% of mine.  This incision allows the best surgical view during the surgery, and allows your surgeon the greatest control over making the pocket, releasing muscle, and placing the implant in the exact right position.  The IMF incision also accommodates all implant types and sizes.  Traditionally, the axillary incision only accommodates saline implants, which are rolled up and stuffed through the axillary incision and then filled with saline once they are in place.  I suppose some surgeons will place smaller silicone implants through this incision, but larger ones will be difficult to place properly.  Always be sure to seek out a board certified Plastic Surgeon!

Karol A. Gutowski, MD, FACS · Answer

In most cases, the choice of incision does NOT influence recovery as healing takes time no matter where the incision is made. Using a Rapid Recovery technique may get you back to regular activities faster but it will still take time for the body to heal. Most plastic surgeons prefer the incision in the breast crease (under the breast) as it gives the best access and control to give an optimal result. It also allows for better muscle positioning in the Dual Plane technique, and may lower the risk of capsular contracture (compared to other incisions). See link below for examples.

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your excellent question. Congratulations on your decision to pursue breast augmentation surgery! Our patients are very pleased with their results, and I am sure you will be, too. With regards to incisions, there is very little difference in healing time, etc, when using a transaxillary versus inframammary incision approach. The main issues with the axillary approach involve dissection of the implant pocket, and the size and type of implant that is placed. Conversely, the inframammary incision is sometimes a concern for patients, but it universally heals well. The size, profile, shape, texture, and type of implant (e.g., saline, silicone gel, “gummy bear”) is based on your desired versus existing breast size and shape, your chest wall measurements, and soft tissue quality. Of course, you will need an in-person consultation to evaluate you for this procedure. Preoperative visualization and surgical simulation with the Crisalix system may help with your decision. Any treatment plan should be based on a detailed discussion with equal input from both you and your surgeon.    Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation in person with a qualified board-certified plastic surgeon. Good luck!
 
 Best,
Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Brooke R. Seckel, MD, FACS (retired) · Answer

The most important thing to consider is the risk of complications such as capsular contracture. The inframammary incision is safer and has less chance of complications such as capsular contracture and implant displacement. I only use the incision under the breast-safer, well hidden and most important the least chance of hardening or capsular contracture-a complication you do not want. Recovery is the same-2 weeks. For more read below:

Healing time and limitations with the BA transaxillary incision verses the inframammary incision?

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