Mia Femtech breast enhancement - Transaxillary incision?

Dear M_Bertrand,

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

There are several concerns here. First, you are traveling to Europe for this procedure and will not be able to have follow up visits with your surgeon. If a revision is needed, what will you do? If you develop a complication, who will you see? Second, this is new technology and is not FDA approved and there are concerns about long term safety. Some disturbing complications have been reported. Do you really wish to take this gamble with your breasts when there are safe and FDA approved procedures in the USA, probably somewhere near you?

Breast augmentation outcomes are based on three variables.
The first is the patient’s candidacy for the procedure.
Candidacy for breast augmentation has a lot to do with breast shape and position on the chest wall.
Variables that may lessen someone’s candidacy for breast augmentation include variables like breast sitting wide on the chest wall or significant breast divergence.
The second variable is implant selection.
With the transaxillary approach silicone implants become challenging.
The third variable is the surgeons ability to put the implant in the correct anatomic location.
It is this third variable that is hampered by thetransaxillary approach.
To dissect the pocket correctly, the surgeon needs to have direct access to where they’re working and this is very difficult if the surgeon is making an incision far away from where the dissection needs to happen.
If the pocket isn’t shaped correctly, then you’ll need a revision and that revision can’t be done well through the armpit.
Personally, I see so many disadvantages to this approach that it clearly outweighs the benefit of other incision options.
Considering the rivision rate of all abreast augmentations (20+% in first five years) and how much revision rates are increased by this approach, I don’t think it’s justified.Most plastic surgical procedures are best done as one procedure done correctly.
You get one shot at doing this right.
If it’s not done right the first time the chance of a long-term quality outcome goes down with each subsequent operation.
I also recommend against traveling long distances for elective surgical procedures.
If this approach was clearly better than it would become the standard of care.
There’s a reason most plastic surgeons don’t use this approach.
The same is true for the trans umbilical approach.
Ultimately, the decision is yours
Those who do the procedure are obviously going to say it’s better and those who don’t will tell you it’s not.
Maybe you’ll find someone who used to do it and then converted.
The procedure does have a learning curve and that should be taken into consideration.
I would say make sure the provider has at least 10 years of experience and if they’re still a proponent of doing it then maybe it’s a viable option.
To me, it seems like a gimmick to get more patients And in that sense probably it works.
Best,
Mats Hagstrom MD