Transaxillary Silicone Implants?

So in two weeks I'm having a silicone breast augmentation by a highly recommended surgeon in my area who specializes in the transaxillary route. However, I'm scared that my implants will be too high or far apart....especially since I'm using silicone and I heard that is harder to do via the armpit. I'm very tall and slender and have a full A cup. What are your thoughts? Will a crease incision have a better result?

Doctor Answers 7

Breast implant incision

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I agree that the trans axillary procedure is more difficult to master and requires special instruments if performing it with an endoscope which is in my opinion an excellent way to place implants. With the use of a Keller funnel this procedure takes  about 30 to 45 minutes of operative time. The peri areola and fold incision work well and are more traditional and usually heal just fine. I think the trans axillary procedure has some distinct benefits for the right patient population. There is no cutting through breast tissue which is colonized with bacteria and can lead to higher rates of capsular contraction. The scars are not on the breast which for some patients is a big plus but others do not want an arm pit incision scar. In terms of recovery I think the axillary incision is nice because there is little risk of the incision opening up so early breast implant compression exercises may be started which many plastic surgeons feel reduces the risk of capsular contraction. Since I offer all of the incision choices to my patients I am not biased as are many doctors who are not able to perform the trans axillary approach. If you are happy with your doctors and his or her explanation of things then you should be fine. Good Luck!

Richmond Plastic Surgeon
4.9 out of 5 stars 62 reviews

Depends on the doctor

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I personally do not do TA  implants-- I think that they end up too high and If you need a secondary procedure, even many years later, you need another incision. My favorite is a circumareolar, if the nipple is big enough ( ie 3cm diameter).

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Transaxillary approaches

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have been shown in recent studies to have a greater risk for contractures.  And often, when your next surgery takes place, an incision is placed on the breast.  If you MUST have the transaxillary approach, then go for it.  Your expert surgeon should be able to help alleviate your concerns and you should be discussing this with your surgeon as the transaxillary approach is  the least common compared to areola and crease approaches.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Transaxillary Silicone Implants?

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I think you are smart to have those concerns as those are significant problems when the axillary approach is done in the wrong body type. Also there is some recent literature out in our professional journals that shows a higher risk of infection with that incision (although I have not exerienced that). As to your specific surgery, it would be impossible to answer without photos.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Transaxillary Breast Augmentation

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Transaxillary breast augmentation in the experienced hands of the select few plastic surgeons should be just fine.  I prefer and often use a crease incision.  I have use this access to place silicone implants and it is a bit more difficult.  The incision does heal very well.   I do not believe that any U.S. plastic surgeon is placing form stable implants via this approach.

Dr. ES


Transxillary breast augmentation

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I am going to be honest here, but I cannot understand why surgeons elect to put silicone form stable anatomical implants in through the axilla. Especially if you go submuscular.

(maybe its a marketing tool!) 

Here's why:

1) In Australia, women wear singlets and sleeveless dresses all the time. Now if you scar well, great news. But if you don't then you have scars potentially visible to everyone. An inframammary scar is only ever visible to your partner. You will never see it yourself, unless you try really hard in the mirror.

2) Inframammary incision, when positioned based on the implants dimensions will keep the scar hidden in the crease.

3) Inframammary incision also gives the best exposure to the pectoralis major muscle. This allows your surgeon to select the most appropriate submuscular pocket without any compromise, eg dual plane 1,2 or 3.

4) IMF crease also allows you to sit the implant exactly where you want it with full visibility. No guess work.

So in summary I cannot see any indication for choosing axillary over inframammary crease.

But if your surgeon is a capable surgeon, which it sounds like he/she is, then you must trust him/her. But do ask him why axillary over IMF crease.

I hope this helps and good luck,

Pouria Moradi, MBBS, FRACS
Sydney Plastic Surgeon

Transaxillary Silicone Implants?

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Although I prefer incisions in the fold, I recognize that that is my preference, and not a standard to hold other surgeons to.  

When you look at photos in the surgeon's office, and the outcomes look good, I would trust the surgeon's judgement. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.