Natural Looking Breast Implants with Transaxillary Incision?

Dear Thea,Thanks for your question.  We almost exclusively use a transaxillary incision for our breast augmentations.  I feel an endoscopic technique is absolutely essential.  The endoscope is a surgical telescope that allows a surgeon to see exactly what he is doing.  This, with endoscopic surgical instruments allows for the surgery to be done precisely, accurately and without bleeding.  If the surgery is not done in this manner, I feel the risk that implants are placed incorrectly is higher.  Some surgeons will use a non-endoscopic approach, using blunt dissection which is done blindly.  Bleeding is not controlled and I feel complications such as incomplete muscle release and asymmetry of the implants are more likely.It is completely possible to get a natural look with an armpit incision, which heals very well and in most cases is invisible.  Please look at our before and after gallery.  All cases were done in this manner.Aloha,Shim Ching, MD

Trans-axillary breast augmentation is becoming an increasing popular method for breast augmentation astechnology continues to improve. There are several misconceptions about axillary breast augmentation.

First of all both saline and silicone implants can be used with this method. Many patients and surgeons that do not commonly perform this surgery don’t know that a silicone implant can be placed from anaxillary incision. The use of the Keller funnel allows a variety of implants to be placed through the axilla easily. Secondly, the incisions in the axilla is just as small as it would be if it was placed around the nipple or under the breast. The incision is well concealed in one of the natural arm creases in the axilla.



Thirdly the use of the endoscope has made the procedure very precise as the entire breast pocket is created under direct vision. This method has become very popular in Miami where I first practiced and now I commonly perform this procedure here in Austin Texas as it avoids putting any incisions on the breast, thus decreasing the chances of altering nipple sensation. Please consult your board certified plastic surgeon to help guide you through your breast augmentation process.

Many excellent Board Certified plastic surgeons around the country do silicone breast augmentations through the armpit.  The use of an endoscope in transaxillary breast augmentations increases the surgeon's ability to see and stop bleeders that could later lead to a hematoma or capsular contracture or both.  Transaxillary incisions make it incredibly easy to go underneath the pectorals muscle, and sub pectoral implants look more natural and have a history of getting less capsular contractors.  Creating a dual plane augmentation is also incredibly easy with an armpit incision, therefore covering the upper portion of the implant with the pectoralis muscle and allowing the lower portion to be outside the muscle, giving the patient a teardrop appearance without using teardrop implants which can rotate.I personally have placed hundreds of implants 600-800 ccs in size through the armpit using the Kellar funnel.  The Kellar funnel is an ingenious invention eliminating non-pathogenic bacteria hitchhiking a ride through the armpit, down into the implant pocket, and therefore increasing the chance of capsular contracture. All in all, you are very smart to consider a transaxillary approach for a silicone breast augmentation, and considering the size implant you desire, you should have a very small incision (approximate 4 cm), and because the normal creases of the armpit are called Langer's lines, the scar should be relatively invisible.  Don't forget, no one, not even your mother, has intentionally looked under your armpits. 

I have performed literally thousands of axillary (endoscopic ) breast augmentations through an armpit incision. The procedure is fantastic as long as the surgeon knows how to perform it right. For those who do not - they will see only problems. Results speak for themselves. Why would you have scars on your breast if you can avoid it?

A variety of
incision options are currently available for breast augmentation surgery.Each of these incisions offers advantages and
disadvantages. The transaxillary approach utilizes
an incision in the armpit.Incisions in
the armpit are well-hidden, but there is the potential for implant malposition
and superiorly positioned implants with this approach.For this reason, it’s important that
the procedure be performed by a plastic surgeon with experience with this technique.Under these circumstances, the results can be
excellent and the breasts can ultimately look very natural.

Natural results are achieved with the transaxillary approach using gummy bear silicone gel implants. The key is to make the pocket for the implant low so that the implants don't sit too high. A surgeon experienced with this approach knows how to make the pocket low enough to avoid this problem.

It is possible to get beautiful results with this incision, however you should find someone with experience. Malpositioning is a common concern and you need someone that has experience to improve your surgical outcome.  

Yes, transaxillary is a great approach for breast augmentation. The most important choice is actually not where your incision is but who your plastic surgeon is. Pick wisely and choose a board certified plastic surgeon with experience in this approach. See the below link on suggestions on how to choose one.

Absolutely! Transaxillary approach with highly cohesive Natrelle 410 or Sientra implants is the only way to go!!!


The transaxillary approach is very misunderstood.  It is much more difficult and technically demanding then directly accessing the breast through an infra-mammary approach or through the nipple.  This is the main reason that most surgeons think it is too difficult or frankly impossible.  As far as riding high, this is technical error.  The entry dissection through the armpit has to be done thoughtfully.  The lymphatics that drain the breast are nearby and should not be disrupted for the future possibility of cancer staging/lymph node detection.  To avoid the lymphatics, one must stay high and avoid traversing the surgical axilla.  If this is done, there is geometric isolation between the entry dissection and the implant pocket and the implant cannot ride into this area.  The second reason that implants may ride high is that it is more technically demanding to develop an accurate and well designed inferior pocket.  Most of these problems occur when an endoscope is used and the actual placement on the body is overlooked in favor of concentrating on the endoscopic monitor.

 

 

In my opinion it just does not make sense to place a scar on the breast in an aesthetic elective procedure unless a lift is needed.  For primary augmentations with class I-II ptosis I exclusively use the transaxillary Cold-Subfascial Breast Augmentation TM.  What this means is that I access the interface of the pectoral fascia and pectoralis major muscle through the axilla (arm pit) and carefully dissect the fascia from the muscle.  The implant goes under the strong supportive fascia and above the muscle.  This is VERY different from "above the muscle" or subglandular techniques which typically do not fare well.  The fascia not only shapes the breast beautifully but the muscle is out of the picture allowing the breast implant to sit naturally more medially than dual plane techniques and it also offers the implant lasting support to prevent bottoming out and undesirable changes.  Live surgical videos have been published on the technical aspects of the Cold-Subfascial Breast AugmentationTM where the delicate dissection can be observed. 

Even the product representatives may believe that transaxillary placement is too difficult or impossible but these beliefs are remnants from early experience decades ago with saline transaxillary augmentation with a 2-3 cm incision.  The reality is that an endoscope it not necessary and the axillary incision heals and nearly disappears in most women and a larger incision in the axilla can be shortened and hidden with suture technique.

Unless the breasts have some pre-exisiting ptosis (droop) prior to the breast augmentation, there should be no reason why breast augmentation performed through a transaxillary (armpit) incision should not look natural.
You mentioned in your question, that often they look to high when you see before and after pictures of augmentation performed through the transaxillary approach.
This is a common mistake with the transaxillary approach. The surgeon must have the experience to know to initially place the implants slightly lower through the transaxillary approach then through the peri-areolar or inframammary approach. When properly performed, implants can look perfectly natural through the transaxillary incision.