As far as healing and minimizing post-op risks, is it better to get an inframammary incision or transaxillary?

I have read a lot of stories by doctors saying that inframammory incisions using electrocautery is less traumatic because there is no blunt dissection and minimal bleeding. They say it is easier to place the implant this way and the healing is faster. I am interested in silicone sub muscular about 275-300 cc. I do not need a lift. I am worried about having uneven breasts or being more prone to capsular contracture if I go with the armpit incision. Thoughts?

Doctor Answers 19

IMF or transaxillary

It's not often I completely disagree with the other surgeons on this site but in this case I do. Based on the answers given thus far it is quite likely that none of the doctors who have answered you have a lot of experience with the transaxillary technique. I became interested in transaxillary technique when I married and found that my wife had axillary incisions that were completely unnoticeable performed by Dr. Dale Dubin in Florida. Even at a few inches away I could not see them and they were far superior than anything I had ever seen in the IMF. So, I tried the transaxillary approach for a few years but was disappointed, for many of the same reasons listed below. However, in the early 90's I was involved in the development of endoscopic plastic surgery and realized that the problem with the axillary approach was that it was blind and that by using a scope to see the anatomy inside perhaps we could change things.Sure enough, visualization was the key and the transaxillary approach now accounts for over 95% of all my augmentations and in fact is easier, safer, less traumatic, with quicker recovery , and with none of the issues you see listed below. Since it requires expensive equipment, specialized training, and experience, it is not a popular method and thus you see the type of answers you have already received below. Many surgeons are hesitant to admit they have no experience with is and you should definitely not have it done by an inexperienced surgeon. However, I do feel it is a superior method for me as long as it is done endoscopically and here is why. 
1. If you don't have to put a scar on the breast ( and you don't) then why do it? Plastic surgery is all about concealing the evidence that we have been there and the endoscope is perfect for this.
2. Visualization is actually better than it is with the IMF approach where you are peering through a small incision with a headlight. In an endoscopic procedure all the structures are magnified and much closer. Thus there is no blunt dissection and no bleeding. Very precise and very minimal if any bleeding. 
3. Early reports of pocket difficulties found in the literature were based on blunt techniques and large incision techniques no longer a part of the procedure. All is done through a minimal incision with fully visualized maneuvers inside the pocket which in my opinion and in my experience is actually MORE precise than peering through a hole at the bottom of the breast. 
4. Recovery is faster because we have the patient at full motion the day of surgery. There is no activity limitation whatsoever as there is with most IMF procedures and we want full range of motion of the arms right away. There are no dressings on the wounds to deal with either. The post operative discomfort is not in the armpit but in the muscle that is cut below and stretched over the implant the same as with IMF incisions. so both procedures have the same degree of post op discomfort.
5. All types of procedures from standard sub muscular, to dual plane, to even subfascial techniques can be accomplished endoscopically. 
6. Personally I find the endoscopic technique easier to do, easier to control, and also with lower risks to my patients. 

Now, to give you an idea about the validity of this technique, let me share with you that last year at the American Society of Aesthetic Plastic surgery annual meeting , where I teach this procedure in a teaching course, sitting in the audience was one of the leading breast surgeons in the world with many publications, who , at the end of our teaching course stated he was changing to endoscopic!!!!  Now that is quite a statement coming from someone who has performed thousands of augmentations. 
For your specific request, the implant you desire can easily be placed in the sub muscular pocket endoscopically. If you decide on endoscopic just beside the surgeon has a lot of experience with the technique. 
I wish you all the best.


Birmingham Plastic Surgeon
4.5 out of 5 stars 11 reviews

I'm 44 years old & I'm planning to do nefertiti or silhouette lift.

Greetings

Thank you for your question. There are variables which may make one incision more desirable than another, but any incision should heal well without significant differences to the overall result or risks. with Slhouette lift it is not used anymore.

Bulent Cihantimur, MD
Turkey Plastic Surgeon
4.9 out of 5 stars 79 reviews

Axillary or inframammary augmentation incision?

Breast augmentation can be performed through various incisions.  There are variables which may make one incision more desirable than another, but any incision should heal well without significant differences to the overall result or risks.  You and your surgeon should discuss these options fully and tailor the discussion to your individual case and desires to determine the optimal incision for you.

David F. Klein, MD
Concord Plastic Surgeon
5.0 out of 5 stars 20 reviews

Incisional approach for breast augmentation

Hi, NYTXSC

As you know, there are several incisional approaches to breast augmentation.  Each has pros and cons.
I do prefer inframammary crease incision as it allows me the best direct visualization of pocket dissection.  Also, it is straight forward with least trauma to breast and nipple areolar complex.
The decision should be based on your preference as well as your surgeon's preference and skill sets.
Please choose your plastic surgeon carefully and discuss your concern.
Best regards.

Transaxillary or inframammary incision.

It is known that  there is a higher percentage for infections that ,may lead to capsular contractures when a transaxillary incision is used compared to the traditional inframammary incision.  This doesn't  mean that a transaxillary incision technique should be abandoned all of the time for the more conservative incision, but it is certainly worthy of consideration.  Most Plastic Surgeons have been trained and experienced in using all of the techniques a ilable, but I must mention that I don't use a transaxillary technique anymore.

Good luck to you.

Frank Rieger M.D.  Tampa Plastic Surgeon

Breast augmentation: inframammary vs. axillary incisions

I appreciate that you are worried about uneven breasts or being more prone to capsular contraction with the armpit incision. I believe either of these problems could occur whether you have an axillary or an inframammary incision, although these problems are not common. I prefer the inframammary incision because I do not have go through or near blood vessels or nerves when I place the implant, like I would with a transaxillary incision. 

Ted Eisenberg, DO, FACOS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 61 reviews

Transaxillary vs. Inframammary incision

Each procedure has advantages and disadvantages.  An consultation would be the best way to assess which procedure would be best for you. Best of luck. Dr. Michael Omidi

Michael M. Omidi, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 62 reviews

Inframammary Vs Transaxillary Incision

I personally did a few dozen transaxiillary endoscopic procedures  from 2009 - 2010 and found they took me longer, were more expensive for the patient, and if there was a need to go back to surgery later, patients ended up with an inframmary incision anyway.

Your question asked about postop risks, and the best answer is that a group of doctors have researched that very question and performed breast augmentation via all 3 approaches: the axillary, areolar, and inframammary incisions.  

Their research showed higher capsular contracture, higher malposition, and also a higher chance of secondary procedures in patients who had axillary and areolar incisions compared to the inframammary group.

As far as healing and recovery, my opinion is that there would be no significant differences. Gentle handling of the tissues, especially the pec muscle along with the use of a muscle relaxer if needed to treat spasm have had the biggest impact on my patients recovery.



John LoMonaco, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 256 reviews

Breast augmentation

For submuscular augmentation, the IMF approach differs from the transaxillary approach in the way the muscle is divided.  Transaxillary technique will lower the IMF about 1 cm to make room for the implant while the IMF approach will divide the muscle but not sharply lower the fold.  In general, implants will sit higher with the IMF technique and give the breast a perkier look.  The TransAx method can result in an increased nipple to IMF distance because the fold is sharply divided.  

John Burns, MD
Dallas Plastic Surgeon
4.6 out of 5 stars 33 reviews

Neither

I prefer a circumareolar incision. I think it heals the best and gives the most inconspicuous scar. I can put the implants either over or under the muscle through that approach.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.1 out of 5 stars 11 reviews

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.