28 years old, petite, 110lb, 200-250 underarm, natural results. (photos)

I would love to have naturally looking breasts. I am a freak about scars, so I chose a transaxillary method. I am thinking of going for 200-250cc. Since I am very skinny and I work out really a lot, I was first considering getting the implants placed under muscle (to avoid visibility and rippling) but I now learned that that method can't be performed when done through the armpit. Please advise on the size, profile and placement. I am posting my pics and pics of wish boobs. Thank you!!

Doctor Answers 14

Transaxillary salin filled breast implants

Thanks for your photos.  Suitable for you will be salin filled implants with about 250-300 cc. They will be set transaxillar. Please consult with a board certified plastic surgeon. Good luck

Turkey Plastic Surgeon
5.0 out of 5 stars 22 reviews

Excellent candidate for breast augmentation

The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast. A round implant would be a better choice because they move more like breasts. The anatomic implants have a textured surface which makes them feel very unnatural. In addition, there is no benefit to anatomical. There is an X-Ray study that shows the implants from the side at 6 months. Standing, the round and the antomical implants have the same profile. When you lie down however, the anatomical implants do not change, which is unnatural. A round implant will change when you lie down, like a natural breast would. HP implants, which are a more modern shape than moderate profile implants, fit most women better. They have a more appropriate base diameter and can be made to look very natural or very augmented, depending on where in the range the implants are filled to achieve a particular volume. High profile implants are the first choice in my opinion. I rarely find an indication to use moderate or moderate plus implants. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of volume, and where in the range the implant is filled. There are many advantages to sub muscular dual plane placement and very many disadvantages to sub glandular placement.  I would see no indication to do anything but sub muscular dual plane.  Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's.  The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher.  The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement.  The blood supply surrounding the implant is worse so the risk of capsular contracture is higher.  The support for the implant is less so there is more long term shape abnormalities and sagging.  The look of a sub glandular implant is much less appealing than a sub muscular implant.  The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful.  There are no advantages to sub glandular implant placement. The choice between saline and silicone is one that requires a complex discussion of all of the advantages and disadvantages of both implants. The issues to be considered are safety, density, mobility, rippling, rupture rate, consequences of rupture, detection of rupture, need for follow-up care, cost of follow-up, appearance, feel, sensation of heaviness, radio-density, mammograms, and costs, among other things. There are advantages and disadvantages of both products. The decision will ultimately be up to you based on what is appropriate for your particular situation. Beautiful results can be obtained with either implant. The best way to determine the size that fits your personal perception of the perfect breast is to try on sizers. This way you can see how they fit on you, how they add to your current volume, and whether they fit your frame. Although the surgeon can guide you, only you will be able to tell what is the right size. Try on sizers. Measuring a diameter and then telling the patient what volume they can have (in high, moderate or moderate plus implants) in my mind is backwards. The patients should be allowed to choose the volume. Then the surgeon carefully considers the base diameter, projection, profile, manufacturer, and fill material that will achieve the patients goals of size as well as qualitative look (natural, intermediate, or bold upper pole fullness or projection), all the while taking into consideration the patient's anatomic features that will affect the outcome. The experience of the surgeon and the degree to which they explain the options to you is of utmost importance. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of implant. Don't let the doctor tell you what would look good on you. They cannot tell what you perceive to be the best size. There is no maximum. That is up to you.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
4.9 out of 5 stars 135 reviews

Trans axillary breast augmentation scar considerations

You mentioned that you were concerned about scars - the armpit (axilla) is an unusual place to have a scar of any type, and you're considering placing scars in both arm pits. I continue to believe that a well placed infra-mammary scar, concealed in the breast fold, is the ideal place to have a breast augmentation scar. Take a look at our before and after photos and see if you can detect the scars.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

Dimensional Breast Augmentation

Thank you for your question and photos. I do place implants under the muscle through the trans axillary route. I recommend that you meet with a board certified Plastic Surgeon in person to discuss all of your options. As for sizing, they will need to measure your breasts in order to provide the specific implant diameters which fit you. This personalised information plus your preferred look will help your Plastic Surgeon to plan for you. My patients find it helpful to try on breast implant sizers in the office in order to get an idea of how they will look.
All the best

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Tansaxillary subpectoral breast augmentation

Of course a tranaxillary incision can be used for subpectoral placement and you appear to be a great candidate for the procedure.  I would guess that you may need slightly larger implants than you stated but a face to face examination would provide a good size recommendation.  I prefer to choose the final implant size only during the surgery procedure when test implants allow me to actually see the results achieved with different sized implants.Watch the video link for more info and enjoy your results.Jon A Perlman MD FACS  Certified, American Board of Plastic Surgery  Extreme Makeover Surgeon ABC TV Best of Los Angeles Award 2015, 2016  Beverly Hills, Ca 

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

You can have a beautiful result with breast augmentation

Hello and thank you for your question! Getting a breast augmentation is an important decision. Looking at your pics, I think you can have an excellent result. Your wish pics show that you would probably be happiest with a high profile implant; the size is best determined based on your measurements. At our office, you would try on implants and put your favorite top on over it to ensure that you will be happy with the ultimate result. The procedure itself is half of the process, but the more important half is your recovery and long-term results. Lowering your risk for potential problems is key. In a straight-forward breast augmentation, I prefer to use the inframammary crease incision because:

1) it is more well-hidden as you have nice lower pole cleavage and have a natural shadow/crease there that will hide your scar; a scar around the the nipple-areola complex is more visible because it sits on the center of the breast and the scar can be quite obvious in some people. 2) it gives a straight-shot access to develop a submuscular pocket and really control the boundaries of your breast pocket made to place the implant: it does not violate your inferior breast border (like an umbilical approach) or your lateral border (as in cases where people use the armpit and then end up with
implants in the armpit). " Pocket control" is key for long-term results.

3) the inframammary crease is the cleanest of all sites compared to the nipple (where many glands and ducts exist), the armpit (where there are many sweat glands and hair), the umbilicus which harbors bacteria. Studies have shown that this decreased bacterial burden also decreases long-term potential for capsular contracture; furthermore, the crease is the least sensitive of all the areas and as patients heal, their scars may get sensitive and the crease decreases scar hypersensitivity issues. Speaking of sensitivity, cutting further away from the nipple-areola complex should theoretically further protect preserving nipple sensation. I think for your optimal outcome, you should go to a board certified plastic surgeon with expertise in aesthetic breast surgery. Make sure to check reviews on yelp/realself/google+/Facebook/etc, before and after photos, following on instagram, for the surgeons you are considering to gain a better understanding of the results they deliver for their patients and then go with someone who fits your needs best. I recommend going to several consultations so that you make a well-informed decision.

Take care,

Dr. Sean Kelishadi

Sean Kelishadi, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 25 reviews

Transaxillary Breast Augmentation

Hello,You were given misinformation about transaxillary breast augmentation.  You absolutely can get silicone gel implants under the pectorals muscle via this route. Go visit a few ABPS certified/ASAPS member surgeons that specialize in breast surgery and perform endoscopically assisted transaxillary breast augmentation.Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

28 years old, petite, 110lb, 200-250 underarm, natural results.

Thank you for the question and photographs.From your wish photos, it appears that you have a very reasonable expectation for implant size and results after surgery. I would expect that you would have a very nice result. Implant can be placed under the muscle even using the armpit incision. Placing implants under the muscle is another layer of coverage to avoid visibility and rippling. My preferred approach is with an incision placed through the crease below the breast. The incision hides within the the natural crease. It's about 2 inches long. The most important factor when sizing implants, is working closely with your surgeon in person to find the implant size that gives you the look that you desire. Careful measurements of your breast and chest wall will help determine which size implants will fit within your natural breast footprint. Taking into account your desired look, and your measurements, an implant is chosen that specifically fits your body.Unfortunately, online recommendations are not that helpful. Make sure that you have a good relationship with your plastic surgeon, so that you two can work together to find the right size. In my office, patients try on implants in a bra and clothing. There able to see how they look in the mirror, and in photographs. Women are also encouraged to bring in wish pictures, so that I can get a sense of the look that they would like to achieve. Good luck with the process!

Austin Hayes, MD
Portland Plastic Surgeon
5.0 out of 5 stars 32 reviews

Under muscle still an option

Thanks for the question and the photos. You can definitely still have an implant placed through your axilla under your muscle. Breast augmentation surgery is a very personalized procedure, so it's impossible to tell what size implants you might need without seeing you in person. The most popular profile for natural looking breasts is a moderate plus profile. In my opinion, once you start getting into higher profiles the breast shape become less natural appearing. My preferred method of placement is through an incision underneath the breast, putting the implant underneath the muscle. If this incision is placed properly and closed well, it its hardly perceptible once healed. Placing the implant under the muscle does give all of the benefits you mentioned (less visibility and rippling) as well as a more natural look. I hope this helps and best of luck!~Dr. Sieber

David A. Sieber, MD
Bay Area General Surgeon
5.0 out of 5 stars 31 reviews

Begging for help.

Congratulations on choosing breast augmentation. It sounds like you have already made some decisions about your procedure and have seeked out at least one surgeon's advice. While I cannot give you actual advice, I can speak about your options and the pros and cons of the decisions you make. For instance, the axillary approach to the breast does create scarring in the armpit which is not invisible when you raise your arms. Of course, the scar is not visible when you arms are down. As far as implant placement, with appropriate technique and an endoscope, a sub-pectoral pocket can be created under the breast and muscle just as with any other approach for breast augmentation. Perhaps, your consultant surgeon does not wish to go under the muscle for various reasons. However, you are thin and I believe your risks of rippling would be dramatically higher if you went above the muscle. This tells me that you should have a few more consultations with different surgeons to really get an education on all options available for your situation. As far as size, what you have mentioned is small enough to lead to a more natural looking outcome, however, there's a risk you may feel they're too small later in life. Therefore, I suggest you size very carefully and visit several surgeons who use the Mentor Volume Sizing System (VSS) in the office. Best wishes always, Dr. Aldo

Aldo Guerra, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 201 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.