When Replacing Implants Can I Go Under the Armpit Again?

Question

I got my current implants in 1995 and am having no problems, but they are starting to sag more than I would like. They are under the muscle and were inserted through my armpit. If/when they need to be replaced, can I go under the arm again? I like the idea of having no visible scars...and my nipples are already almost completely numb, so I dont' want to risk any further loss of sensation.

Johnny Franco, MD, FACS · Answer

An axillary incision is similar to a peri-areolar or IMF
incision in that you can do the initial augmentation though the incision and
exchange implants through the incision. 
It is a common myth that silicone and large implants cannot be placed
through an axillary incision, both of those are not true.  I routinely place large silicone implants through
an axillary incision.

Women many times decide they would like to change the size
of their implants for whatever reason. This can easily be done through the
axillary incision.  With the use of the
endoscope and specialized equipment the implant can be removed, the pocket
adjusted and the new implant placed with the use of the Keller funnel.

Please be sure to consult with your board certified plastic
surgeon.

Richard Baxter, MD · Answer

Since many patients over the course of their lives will require an additional procedure, and it cannot typically be done through the armpit incision, I am not a fan of that approach. You will end up with another scar anyway. Correction of sagging for example cannot be done though the armpit.

Otto Joseph Placik, MD · Answer

If you plan on replacing implants through your existing armpit incision, it may be difficult to correct sagging (ptosis)

Vincent N. Zubowicz, MD · Answer

Revisions through the axilla are more difficult because breast is somewhat remote, but it is not impossible. I use all three approaches at the patient's request. I don't see much difference when the scars remodel. There is a lot of lip service paid to placement of the incision, but in the end, I don't think it makes much difference,

Gregory A. Buford, MD, FACS · Answer

While the trans-axillary approach is great for avoiding incisions to your breast, it is not so great in the long run if you need a revision.  And, given the fact that a majority of women will revise their augmentation at some time, the need for either a IMF or peri-areolar incision then arises.  If your breasts are less perky now, you could potentially add more volume through a larger implant or you may need a breast lift.  Either way, you will most likely need an additional incision to perform this revision.

	I hope this helps!

Babak Dadvand, MD · Answer

The only advantage of going through the armpit is that there are no incisions placed on the breast. However, this initial advantage is usually lost when it comes to breast implant revision surgery. The only reason to go through the armpit again is if you just want to change out the implants. If there is any sagging or droopiness to the breast, then going through the armpit will not work.

	In fact, you will trade one problem for another. Typically when a woman needs a breast lift and just has implants placed, it results in something we call "Snoopy" deformity, named after the cartoon dog. This is because the breast tissue falls off the implant and it looks like Snoopy's head in profile.  If you really need a breast lift, there is no way to avoid incisions on the breast. Now the amount of incisions you need, whether it's just around the areola, a lolipop, or an upside T incision, depends on 2 things: 1) How low your nipples are and 2) How loose the skin is.

Samer W. Cabbabe, MD · Answer

If you are only wanting the implants replaced, going through the armpit is fine.  However, new scars will be necessary on the breast if you also need a lift.

Steven Wallach, MD · Answer

If you have sagging breasts then a revision will most likely require a lift of some sort. This will unfortunately add an incision on the breast.

Peter A. Aldea, MD · Answer

Your question will no doubt elicit a lot of responses. Some will be factual and others will be preference based. We are after all products of our experiences, good and bad.

You have hadyour implants for 15 years. If they deflate and you wish to replacethem with the same or slightly larger breast implant this could readily be done through an armpit (transaxillary) incision / scar. But the incision cannot be used to lift a sagging breast not to remove a capsular scar or do several other procedures.

As regards the around the nipple complex (Periareolar) approach VS. the armpit approach, your nipple numbness demonstrates that blind creation of the implant pocket (especially along the side) is responsible for such numbness NOT the scar placement. A periareolar approach provides the best visibility of all breast augmentation incisions, it allows the surgeon to see the sensory nerves in many cases and to avoid them and unlike other incisions it can be used to lift a sagging breast AND to be used over and over again. 
In short - an uncomplicated implant exchange CAN be done through an old armpit scar. Anything larger would be a challenge and would require another incision / scar. IF you faced that decision, I would highly recommend you consider a periareolar approach.

Dr. Peter Aldea

When Replacing Implants Can I Go Under the Armpit Again?

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