Transaxillary breast Aug- DFW - possible to do transaxillary incision for silicone implants?

Question

Hello, I really want to mitigate scarring around the breast, I was wondering if it is possible to do transaxillary incision for silicone implants thinking around 300 CC. If so, how does it compare to the typical below breast incision, is 24 hour recovery still possible? Also are there any differing implications with this incision type? For example, a link to breast cancer or higher revision rates I have seen a lot of mixed information from different surgeons. Thank you!

Daniel Barrett, MD · Answer

Dear b.mo24,
I tend to prefer the periareolar incision because its the most well hidden. There is a natural border between the areola and the rest of the breast skin the hides the incision extremely well. You have to be completely naked to see it vs other incisions like transaxillary and inframammary are visible in clothing such as sleeveless shirts and bikini tops when extending your arms up. I've also noticed increased rates of bottoming out with inframmary incisions that is not reported. Transaxillary implants are always wide in appearance because the surgeon is not able to dissect medially enough to provide better cleavage. Ultimately, I can perform any of the incisions but I recommend the periareolar. There is no difference in sensation because the nerves that control nipple sensation come in laterally from the back and injury to them occurs when surgeons dissect to far laterally which is why transaxillary incisions have the highest nipple sensation disruption. There is no difference in breast feeding ability. One study did show a slight increase in capsular contracture with use of periareolar but that study was small and did not incorporate modern techniques such as below muscle placement, keller funnel usage and triple antibiotic irrigation. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

Yes you can utilize the transaxillary approach with silicone implants however I use this approach the least.  It comes with a higher risk of malposition.  The surgeon is not able to visualize the pocket during surgery.  The inframammary incision is the most common and has benefits such as lower capsular contracture rates.  I encourage you to discuss the pros and cons with your surgeon to determine the best approach for you.

Gregory Turowski, MD, PhD, FACS · Answer

Yes it can be do ne i have performed many even 800cc (the biggest available) breast augmentations through the armpits. Recovery is the same or better and certainly no higher risk of breast cancer or any complications
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.

Richard Zienowicz, MD · Answer

Hello and thank you for your question. I have done almost exclusively transaxillary breast augmentation for over 30 years. I use a  small incision using a Keller Funnel. I personally don't use endoscopy in my cases but some surgeons do. I agree with others that it takes longer than 24 hours to recover from any breast augmentation surgery.  There is no known higher revision rate or link to breast cancer that I am aware of - I would recommend going with a board-certified plastic surgeon who specializes specifically in transaxillary approach as they are the most comfortable going with this approach and can avoid the pitfalls such as an implant placed overly high.

Douglas Taranow, DO, FACOS · Answer

I routinely perform transaxillary breast augmentation with silicone implants as large as 550cc's (although these larger implants are difficult to insert).  
There is no difference in the postoperative recovery vs inframammary incision or the periareolar incision.  
Submuscular placement is certainly more painful and takes longer to recover vs subglandular, but submuscular placement has several benefits (less percentage of capsular contracture, less visualization of the upper pole of the implants with a more natural slope superiorly).
Best wishes.
Dr. Taranow

Transaxillary breast Aug- DFW - possible to do transaxillary incision for silicone implants?

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Transaxillary breast Aug- DFW - possible to do transaxillary incision for silicone implants?

Answers (6)

Answer: Transaxillary Breast Augmentation

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