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

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.

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.

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.

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

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