Is there a difference in scarring when getting a transaxillary or a inframmary incision?

Question

Does sweating or lots of arm movement affect the transaxillary scar? I am military police so I use my hands A LOT. Whether it’s driving, carrying rifles, etc. I also wear a tactical vest on the reg carrying around 20lbs on the reg. I’m not so worried about the healing process of my implants because I will be taking days off, however, once I can be involved in vigorous activities, I’m afraid the scar will not look so discrete.

Gregory Turowski, MD, PhD, FACS · Answer

I do not think there s any more risk /discomfort with armpit incision and you have a real benefit of not having ugly scar on you breasts, For me it is a no brainer why to have ugly scar (yes it will be there no matter what they say) to show on your underboob if you can have none....
I think a lot of surgeons are against transaxillary breast augmentation because they do not feel comfortable performing it or they even never tried or got train in performing it. I learned how to safely and successfully perform this type of breast augmentation over 25 years ago. Since then I augmented many thousands of breasts this way and this is my experience: it is my preferred way to do it (for a right candidate) my main reason is: why mutilate perfect beautiful woman's body if you can avoid it? And there is really no downside, it is not true that are more complications, problems or capsular contractures than with any other way to do it. If surgeon is skilled and knows how to perform axillary breast augmentation results are very predictable. I would not be repeating this procedure for over 25 years if it would be causing problems. It would be insane since I sometimes have 10 patients /week and would ha to deal with a lot of unhappy women... And do not trust surgeons who tell you under the breast incision is great. Frequently, they are quite visible, stretched, dark, keloidal and quite annoying. Especially in small breasts that have no folds make these scars impossible to hide. Last time I performed inframammary incision is over 20 years ago. There is no need for that. Armpit incisions ALWAYS heal great, and they are either invisible or look like a wrinkle in your armpit. And in my experience problems that people are describing are if anything less common that with other approaches.

William R. Burden, MD, FACS · Answer

Of the three incisions, Transaxillary, Periareolar, and inframammary fold, the transaxillary incision is under the least tension.  As all Plastic surgeons know, a tension free closure of a wound is highly desirable for wound healing and scar formation.  Using fiberoptic technology, the transaxillary approach has the greatest precision of placement.  I presented an abstract at the SESPRS in Boca Raton Florida clearly showing the low contracture and zero infection rate using the transaxillary technique.  The highest infection rate is through the periareolar incision.  The second highest through the inframammary fold and the lowest through the underarm incision. The implant is placed in the dual plane position using the transaxillary technique which has the lowest contracture rate.  Finally the scar is well hidden in the crease under the arm.  When you are topless the underarm incision is the only incision that is not seen on the breast.

Daniel Barrett, MD · Answer

Dear arlala,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

Graeme J. Southwick, MBBS, FRACS · Answer

Hello and thank you for your question. The quality of scarring after breast augmentation will depend more on the expertise and techniques used by the surgeon than in their actual placement. Transaxillary incisions do not feature as much tension, which might make for a better scar outcome. However, incisions inside the breast crease are usually safely hidden underneath the breast and the access allowed typically offers a superior breast augmentation outcome for patients. Make your incision choice based on the experience of the surgeon and the type of implant used and you will likely see the best possible results no matter with incision is used. Good luck!

Richard Sadove, MD · Answer

The Infra mammary incision is most commonly used, as it was shown to have the lowest risk for postoperative bleeding and asymmetry. For these and other reasons, I personally would not use this approach. Please seek a second opinion.

Is there a difference in scarring when getting a transaxillary or a inframmary incision?

Answers (6)

Answer: Transaxillary versus Inframammary Incision

Answer: Transaxillary versus Inframammary Incision

Answer: Trans axillary Incision

Answer: Trans axillary Incision

Recommended reading

Everything you need to know about Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.

Is there a difference in scarring when getting a transaxillary or a inframmary incision?

Answers (6)

Answer: Transaxillary versus Inframammary Incision

Answer: Transaxillary versus Inframammary Incision

Answer: Trans axillary Incision

Answer: Trans axillary Incision

Browse related questions

Recommended reading

Everything you need to know about Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.