Was Told by My Surgeon that a Second Armpit Incision to Replace Implants was not an Option, Is this True?

I am considering replacing my implants - done thru armpit incision - with slightly larger ones, but was told by my surgeon that a second armpit incision is not possible. Is this true and why?

Doctor Answers 11

Was Told by My Surgeon that a Second Armpit Incision to Replace Implants was not an Option, Is this True?Answer:

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I have used the underarm incision for more than 10 years and I almost always use the endoscope and use it to replace implants all the time...I use the Keller Sleeve if I am doing gel implants greater than 400cc...It is a great approach, but I do think that using the endoscope is crucial...

Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

Transaxillary incision for replacement implants

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I tend to agree with your surgeon's recommendation.  If you use the inframammary or areola incision, the physician is directly at the surgical site.  Therefore, he/she have complete control and total visibility.  The underarm incision is further away and can't correct any shape issues etc.

Second arm incision for implant revision/exchange

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Depending on what is done with your revision surgery, it may be difficult to impossible to do through the arm pit incision.  The "work horse" incision in the inframammary fold allows more direct access and is needed in most revision surgery.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

Breast Implant Revision Through An Armpit Approach

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With a transaxillary approach to your first surgery, you undoubtably have saline implants. While it is possible to replace your existing implants through the old incision with an endoscope it is difficult, particularly if the pockets need adjustments. If it is just an implant replacement with no pocket modification, then it is less difficult. Regardless of what is needed, revising your implant is easier on both the surgeon and your recovery if you consider changing to a lower inframammary crease incision.

Transaxillary revision

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It is sometimes difficult to redo implant surgery through the armpits because of limited visibility of the pocket.  If using an endoscope it may be possible. 

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Replacing implants through transaxillary incision

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The transaxillary approach is not optimal if the breast pocket requires revision or you have developed capsular contractors. Of all the incisions, this is the "blindest" approach to the breast and the risk of complications in an implant exchange would be higher as a consequence than with the inframammary or circumareolar approaches.

Revisionary Breast Surgery Approach?

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Thank you for the question.

Generally, this removal and replacement of breast implants is all that is planned that it can be done through any approach. However, if additional work as planned  (for example, adjusting the breast implant pockets and/or removing scar tissue)  than the trans axillary approach may not be the best approach to use.

Assuming your surgeon is well experienced with the visionary breast surgery you may want to ask him/her about the reasoning behind his/her recommendations.

I hope this helps.


Possible does not always mean it's in your best interests

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Hi there-

I'm guessing here, as I obviously don't know you or your surgeon, but...

I think what your surgeon was trying to say to you is that, in his hands, and given your particular set of circumstances and goals, it would not be advisable to try to do your operation using another armpit approach.

This doesn't mean it can't be done. Just that he doesn't think it's the right way to go.


Transaxillary incisions

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My article on over 1600 transaxillary augmentations (the largest series to date) was just published in the Aesthetic Surgery Journal in September of 2011, which is the official Journal of the American Society for Aesthetic Plastic Surgery.  About two thirds of the time, I was able to go back through the armpit incision for any revision needed.  The times where that is not possible is if there is a capsular contracture bad enough that you have to remove part or all of the scar tissue around the implant.  There are those doctors that are not comfortable with that incision, and if they are not comfortable with that incision, you probably would rather go to someone that is.  It takes more work from the patient and from the doctor to use that incision, but to keep all the scars off of the breast if you can is many times worth it.  Good luck in your search.

Dan Mills, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 35 reviews

More information about the reason for exchange

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If you have silicone gel implant and your surgeon is concerned about the implant leakage or there is a need for the implant pocket revision, then transaxillary incision is not a good option.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

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.