Inframammary vs transaxillary for mild eds NATURAL look, low ccs gels. (photos)

Mom and I self diagnosed mild eds (hyperextend, soft, stretchy, bow legged) no healing issues. I want cohesive gels for natural look/keep them in place. Mom had BA 10y ago and they're great. It seems inframammary is ideal but I have no crease and am worried they won't hold/will bottom out. Hers were transaxillary but I worry I can't get the natural effect that route. Do you have experience with mild eds and incision placement/implant type/what would you reccomend?

Doctor Answers 8


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Actually, with an inframammary incision there will be MORE predictable control of positioning the implant without any increased risk of bottoming out. In addition, your risk of capsular contracture is lower though the inframammary scar versus transaxillary. Done well, either approach can achieve a nice result.

Axillary vs inframammary incisions

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There are advantages and disadvantages of both axillary or inframammary incisions for breast augmentation, however, in my opinion, and for many years, I use the axillary approach.  Essentially there is hardly any scar and it is totally hidden.  Neither incision have anything to do with "bottoming out", which depends on the skill of your surgeon.

Malcolm A. Lesavoy, MD
Beverly Hills Plastic Surgeon
3.9 out of 5 stars 11 reviews

Breast Augmentation

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Hi Happy Girl!"Mirror-mirror on the wall, I am my Mother after-all."  You could just do what your Mom did.  You have perfect anatomy, and could do whatever.  See the video below and a journal article giving you solid information.  Because of "eds" you might want to avoid a CUT on your breast. The Aesthetic Surgery Journal published an article several years ago proving that the armpit incision has less bacteria than the breast fold incision or the nipple incision.  This paper, published on April 26, 2011 by Dr. Sophie Bartsich, is from the prestigious New York Presbyterian Hospital and Columbia University Medical Center and is titled “The Breast: A Clean-Contaminated Surgical Site”.  The investigators proved scientifically that the nipple region demonstrated a bacteria concentration which was five times higher than the breast fold site which demonstrated a concentration four times higher than the armpit (axillary) area!  Much has been published in our plastic surgery journals on the armpit breast augmentation in recent years. Another study which is in the link below from the Aesthetic Surgery Journal showed a lower infection rate than normal in 2,000 patients undergoing an armpit (axillary) breast augmentation.  These Plastic Surgery Journals are “peer-reviewed” and edited, they are the gold-standard in our field as being valid science.  You may review the web reference below from the Aesthetic Surgery Journal and you will see the axillary BA method outlined.  The website below also has videos showing patients with axillary incisions demonstrating the quick recovery routine postoperatively. All the best, "Dr. Joe"

Which incision

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Considering you have no healing issues, you should do well with either incision.  Most commonly, silicone implants are placed through an incision in the inframammary fold.

Christopher Costanzo, MD
Thousand Oaks Plastic Surgeon
5.0 out of 5 stars 40 reviews


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Thank you for the question and you are an excellent candidate for which ever approach you desire and should get the result you are seeking.  What is more important is your choice of surgeon so go on several complimentary consultations,  look at photos,  compare fees and find your surgeon
Dr. Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 65 reviews

Consider infra areolar approach...

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Thank you for the question. Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery.  

There are several good approaches to breast augmentation surgery; different surgeons will have their own preferences. In my practice, I prefer the inframammary or infrareolar approach for most patients.  

Despite what you may hear, I think most patients can have the infraareolar incision used regardless of the size of breast implants or size of areola. The Keller funnel has made the insertion of all sizes of breast implants much easier. I think of the funnel has also made it easier to perform a true "no touch" technique ( potentially decreasing the incidence of breast implant encapsulation).

Personally, I think the advantages of the infraareolar incision far outweigh any theoretical disadvantages. These advantages include proximity to the planned dual plane submuscular pocket dissection, relatively hidden/forgiving location of scarring, coverage by clothing/swimming suit etc. Best wishes.

Breast augmentation incision placement, Ehler-Danlos.

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i have some experience with Ehler-Danlos patients and in my limited experience I have not seen wound healing issues.  I have been using the tran-axillary approach with endoscopic assistance  for 20 years and I have not had  more implant malposition problems than with either the trans-areolar or infra-mammary incision With your limited tissue you are at significant risk of bottoming out.   If you showed up in my office I would recommend the trans-axillary approach using a Keller funnel to place smooth gel implants in the sub-pectoral position. Regards Dr. Kiener.

Breast augmentation

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Over the years I have noticed that transaxillary breast augmentation has a higher rate of asymmetry and long term complications than an inframammary approach. If you are worried about the scar, don't be, it heals well and when placed appropriately it is hidden and not noticeable. 

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.