What is the ideal distance for incision through the armpits in a breast augmentation? (Photo)

Question

Hello, I am going to have a breast augmentation through an axillary incision, the last doctor I saw said that for him the ideal incision would be 12 cm away from my nipple, but this region is very exposed, it is not a discreet area. Anyone can see the scar, even with my arms closed. He said he couldn't go any further as the equipment wasn't long enough for more than 14cm. I went to 8 surgeons, 6 of whom agreed to do it from 15cm. So... what is the ideal distance for incision?

Daniel Barrett, MD · Answer

Dear Warmhearted591036,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Carlos Marciales, MD · Answer

The distance could be between 12-15, in both cases the scar will be hide, and with time you won’t se it

Ronald J. Edelson, MD · Answer

Almost every surgeon I know has tried transaxillary breast implants and given it up after a short time. You should reconsider going under the breasts

Bruce K. Smith, MD · Answer

In my practice the position of the scar is placed high in the axilla but everyone is different in the position of the natural creases under the arm. In most patients there is a crease at the apex of the axilla and then a second crease that is approximately 1 to 2 cm. below the apex. The incision for transaxillary breast augmentation is usually placed in this second crease. The incision can be made in the apex crease but great care must be taken to avoid the axillary vein and artery and there are nerve branches from the brachial plexus that travel in this area. Injury to these structures can be avoided by using the slightly lower crease. The placement of the scar is still very high and so it is hidden by its position and the fact that is is placed in a natural crease.

Camille Cash, MD · Answer

If your surgeon states that it is not possible to place the incision further due to the equipment length then that's as far away as it can be done.  Be sure you understand the risks and benefits of this particular approach.  The preferred approach in my practice is inframammary.  These incisions give the surgeon the best visualization of the pocket and tend to heal very well for the majority of patients.

Connie Hiers, MD, FACS · Answer

There is no ideal incision because of the differences in women's anatomy. The length of the instrument is the deciding factor.

What is the ideal distance for incision through the armpits in a breast augmentation? (Photo)

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