Should I Get an Incision Through the Armpit or Not? (photo)

Want minimal scarring..getting a BA of 250cc, cohesive gel, teardrop. I want the armpit incision. My surgeon has recommended that i go for the inframmary incision, but he will do the armpit incision if i prefer it. i feel like more things could go wrong with the armpit incision opposed to the inframmary incision now, i am 5ft2, have a cup A breast and have a slight fold on the breast which has made me believe that the incision will be more noticable since the scar will be max of 7cm. opinions? (pic below)

Doctor Answers 13

Trans Axillary Incision

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I am a big believer in the Transaxillary approach and published the largest series ever reported in the Aesthetic Surgery Journal on this approach to breast augmentation.  That being said, I believe that you would be best served by going with the recommendation of your Board Certified Plastic Surgeon for what he or she feels more comfortable doing.  You want to be routine when you are having surgery, not out of the ordinary.  In my opinion there are multiple reasons for why you would pick the transaxillary approach such as never really coming in contact with the breast tissue, and this has many benefits.  But the largest is having no incisions on the breast (my largest incision for a 500 cc implant is about 5 cm) and the fact that you can hide it in your armpit crease.  Good luck.  

Orange County Plastic Surgeon
4.8 out of 5 stars 35 reviews

Why the armpit incision for augmentation?

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Definitely, the incision and the resultant scar are important when talking about breast implants. The armpit incision does avoid a direct scar to the breast, but the surgery is more likely to have asymmetries to the pocket and the fold. These problems occur because the surgeon is working through a small opening a far distance from the pocket. Also, when using gel implants a wider path is required to pass the implant to the breast. With this wider path there is a tendency for the implant to shift towards the armpit especially when one lays flat. So, today with the majority of implants used being gel implants the Inframammary incision is preferred and recommended by the manufacture. The implants can be inserted through an incision measuring 5cm safely.

Jeffrey W. Hall, MD
Austin Plastic Surgeon
4.4 out of 5 stars 19 reviews

Form stable implant best placed through a breast fold incision

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A cohesive gel, form stable (tear drop) implant has to be placed in a specific orientation.  It is designed like that.  A round silicone implant can be placed through an arm pit incision without concern since it does not matter how its oriented.  If you have decided on a form stable implant I would recommend following your plastic surgeons advice and using a breast fold (inframammary) incision.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Which incision for augmentation is best?

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As you have seen, there are many ways to place your implant.  A recent study suggested higher capsular contraction rates when using the axillary approach compared to the peri-areolar or infra-mammary approach.  Anatomic implants require precise placement and pocket dissection of they will look funny.  If your surgeon is confident this will be best for you (after considering your concerns, occupation, clothing preferences, etc) and you agree, then certainly go for it.  You should educate yourself on your doctor's revision policy just in case your result leaves you with less than satisfactory results and whether he/she will limit your scars to the armpit or will they now use another incision should a revision be needed.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Incision for gel implants.

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The inframammary incision is typically well hidden by the volume of the implant and allows the surgeon to work directly in the area to develop the necessary pocket. Using the axillary approach requires a plane or tract in which the implant can ride up. Using the tear drop implant also is a bit more tedious to keep the larger pole in the inferior position which is easier from the inframammary incision.  

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 13 reviews

Breast augmentation -getting it right the first time

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Your breasts are asymmetric with the left large than the right, the right nipple higher than the right and the left inframammary fold lower than the right. If you just put in implants you will magnify the asymmetry. It does not matter in that case how you put them in (nipple, fold or armpit). If you try to lower the fold on the right at surgery through the armpit without using an endoscope you will be at high risk for a double bubble on that side after surgery. Whatever approach you decide to have you need to make sure your surgeon accounts for the asymmetry and has a plan to address it.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Transaxillary Approach and Teardrop Breast Implants?

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Thank you for the question and picture.

In my  opinion, the trans axillary approach and use of "teardrop”  breast implants  are both relatively problematic compared to infra areolar or inframammary incisions and the use of round breast implants.  I would suggest that you concentrate on achieving the results you're looking for while minimizing the potential need for further surgery.

Best wishes.

Arm pit incision question

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I perform most of my breast augmentations using an arm pit incision and place a saline implant under the muscle with a one inch incision and the use of an endoscope. Using a Keller funnel a  smooth round silicone gel implant may be placed through a 2 inch incision. I would not  attempt to place a cohesive teardrop gel implant through an arm pit incision. I hope this helps. Please see a board certified plastic surgeon.

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 62 reviews

Cohesive gels and incisions

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The cohesive gel implants require a larger incision. I think in general that the cohesive gels are tough to get in through the armpit.  

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast implants "through the armpit"

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All patients want a natural look with minimal scarring.  I think you can see from the other answers that the incidence of uneven looking breasts is higher when it is done transaxillary (TA) ("through the armpit").  I believe that too.  I favor the incision at the edge of the areola (PA) or under the breast (IMF).  If you really want TA approach, make your surgeon show you lots of befores/afters so you can see their results.  A good surgeon is happy to do so.  Best of luck to you. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.