Am I a good candidate for transaxillary method Breast Augmentation? (photos)

Question

I am getting my breast done soon and going through the armpit. Am I a good candidate for this method?

Donald R. Revis Jr, MD · Answer

Good morning,
In a single word- no. A lot of patients think that's a great idea, but as a surgeon I know I have seen some terrible armpit scars that cause webbing when you outstretch your arms, and the huge gap you have is very imprecisely corrected through the armpit approach. I specialize in revisions and first timers, and of all the possible incisions, the transaxillary has the highest rate of revision. Implants often sit way too far aprat and fall up and out into your armpits when you lay down, or the surgeon carelessly overdissects the midline and you wind up with synmastia. A perfect example of a procedure where just because we can do something doesn't necessarily mean we should do something. It is falling into disfavor, much like the transumbilical approach (also a terrible idea) did many years ago.

Gary M. Horndeski, MD · Answer

Transaxillary method can be used in your case. However, in your frontal view, your nipple-areola complex is pointing outward. The implants will have to be centered underneath the nipple-areola complex and will make the pointing look even worse. I recommend you consider a mini breast lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Harry T. Haramis, MD, FACS · Answer

I’ve used the transaxillary approach in the past, but would caution.

The pocket and implant can ride high afterwards and it can cause bleeding, etc.

Inframammary or at the fold has advantages which should be discussed during consultation with a plastic surgeon

Daniel Barrett, MD · Answer

Dear Princessy9685,
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

Ronald J. Edelson, MD · Answer

Transaxillsry breast augmentation has been around quite a while but most plastic surgeons don't use it. The main problem is that if you need further surgery later on you will need a different incision. The inframmamary incision heals so well and offers better control and visualization. Most plastic surgeons who have tried transaxillsry give it up after a while. There's no great advantage to it

Derek Fletcher, MD · Answer

Yes, you are a reasonable candidate for transaxillary breast augmentation. Your inframammary folds (breast creases) appear symmetrically positioned and there does not appear to be a suggestion of tuberous deformity. If either of these characteristics are present, using the inframammary fold is usually a incision is a better option because it positions the surgeon to directly address those issues.

Camille Cash, MD · Answer

There are pros and cons to each method of placing breast implants.  When the implants are placed through the arm pit the scar is unobtrusive since it's hidden well in the under arm.  However there can be issues with malposition as the surgeon is not able to observe the pocket.  I prefer the inframammary incision as I'm able to visualize the pocket, clean it with antibiotic solution, and observe potential issues. Discuss the pros and cons of each with your surgeon to determine what is right for you.

Richard Wellington Swift, MD · Answer

Thank you for posting your photos with your interesting question. I would bot recommend a transaxillary approach because there is far less control of the pectoralis muscle release and therefore more problems with breast implant malposition.  This is an operation of augmentation with the fewest problems like malposition and capsules contractures which is hardening of the breasts. You can have a short incision and it will heal well. A duel plane technique will be helpful and you do not need a lift. I recommend that you have a consultation with a Board Certified Plastic Surgeon who is experienced with breast augmentation and see their before and after results. Best wishes, Richard Wellington Swift, M.D., F.A.C.S.

Connie Hiers, MD, FACS · Answer

Yes, you are a good candidate for this method. I do not use the axillary incision because it has the highest risk of capsule formation because of the location in the arm pit with numerous sweat glands. 
 It may be a difficult incision to reuse when the implants need to be replaced.

William B. Rosenblatt, MD · Answer

I would not recommend a transaxillary approach. It is too limiting regarding sizes and types of implants. It appears as if a circum areolar approach would give you a minimal scar and allow full access for surgical treatment.