Is 700cc augmentation realistic through transaxillary incision?
Doctor Answers 7
Implant size, incision, and filler option?
It is great that you are researching before the consultation regarding what you are hoping for. However, when you set expectations, make sure you are setting them with flexibility.
I will first address your question over implant size, then talk about incision, and finally the type of implant (saline vs silicone)
First, when you have the consultation, make sure you consult with a board-certified plastic surgeon. They will assist you in choosing an implant that is more tailored to your breast characteristics in order to provide natural looking breasts that fit your body dimensions. The more you deviate from the proper fit, the more fake your breasts will look.
Surgeons use what is called tissue-based planning. The planning takes into account the effects of implants on tissues over time, risks of excessive stretch, excessive thinning, visible or palpable implant edges, visible traction rippling, ptosis (Sagging), and breast tissue wasting. To determine the implant size, breast measurements must be made: 1) Base Width of the existing breast tissue, 2) skin stretch, and 3) Nipple-to-Inframammary Fold distance. The combination of these measurements will help determine tissue coverage and the required implant volume to optimally fill the breasts.
If you choose a large implant that exceeds your breast boundaries, or which overly stretches your breasts, or is too round, then it will make your breasts look unnatural. In fact, there is higher likelihood of bottoming out (i.e., an empty upper pole, nipple sitting too high on the breast), double bubble deformity, implant malposition, implant visibility, breast sagging, and breast tissue wasting. So going big is good, but going beyond limits will get you in big trouble…pun intended.
So you cannot choose an implant size just yet, but definitely plan the looks you are hoping to achieve and gather photos of them to show to your surgeon.
With regards to the limit of the implant size through the transaxillary incision, you cannot have anything over 500 cc if it is silicone gel implant. However, if it is a saline implant, you can get any sized implant within a reasonable limit of your breast boundaries. This is because silicone gel implants comes pre-filled and their volume cannot be manipulated in any way during the surgery. A saline implant comes in a deflated form, and can be filled with salt-water once the implant device is inserted through the incision.
When you choose the incision, the main goal should be to choose an incision site that will minimize scarring, allow safe creation of the breast pocket, safe insertion of the implant, and amazing results in the long-term.
There is no incision site that is best for all patients and the decision must be tailored to your breast characteristics in collaboration with your surgeon.
Allow me to describe pros and cons of the inframammary and transaxillary incisions, and reading them, understand that many surgeons prefer the inframammary incision and that it is best suited for you if you would like a large implant.
Inframammary (under the breast)
- Surgeon has direct vision of the breast pocket and more surgical control reducing chances of breast tissue damage, implant damage, bleeding, and complications like asymmetrical breasts
- The implant can be placed “under the muscle” or “over the muscle”
- Any type and any sized implant can be inserted using this incision site
- Critical nerves and blood vessels are unlikely to be damaged reducing the chances of changes in nipple sensation
- The scar could be well-hidden within the crease of the breasts
- Can easily provide a natural or fake look depending on your preference
- Rate of capsular contracture is very low as the level of endogenous bacteria is lower compared to the transaxillary incision
- Although the scar would be hidden under the breast, it may sometimes move onto the breast, worsening the aesthetic looks with the implant bottoming out. This happens because the inframammary fold which acts as a support structure for the breast becomes weak.
- This approach is not suitable if there is areolar asymmetry or areolar herniation
- It is less desirable in patients who have glandular tissue asymmetry which requires reshaping of the breast tissue
- Who is it for?
- The inframammary incision site is best suited for patients who have a small areola (dark pigmented skin around the nipple), and those who require large implants or form-stable implants
Transaxillary (within the armpit)
- The Incision scar will be hidden within the armpit
- There is less damage to the breast tissues while dissecting an implant pocket compared to the periareolar approach
- With proper technique the rate of capsular contracture is low relative to other sites
- No muscle is cut, the implants simply slides into a natural sub-muscular space
- Relatively quick surgery, shortest time under anesthesia
- This procedure requires that your surgeon is well experienced in this technique as it is a “blind procedure” meaning your surgeon will be unable to see 1/3rd site of dissection to create the breast pocket and if your surgeon is not skilled, it will require revision surgery for complications like breast asymmetry and implant malposition. This means that implant may sit up higher on the breast, and look more fake.
- If a revision surgery is ever required, it is more difficult to do it through the axillary incision and a new incision may be required - most likely the inframammary incision.
- The surgeon will be limited to place the implant behind the muscle
- There is more bacteria in the armpit, however, with the keller funnel – no-touch implant insertion, the implant will not be contaminated.
- Who is it for?
- The axillary incision approach is most suitable for patients who have great concerns about having a scar on the breast and those who have a small areola, and require a small silicone or saline implant
Finally, let’s talk about the filler options and the pros and cons of saline vs. silicone
Saline implants:Pros and Cons:
- Appear in a non-inflated form that allows their volume to be adjusted during operation to make aesthetic looking breasts
- Their non-inflated form also allows them to be inserted without having a large incision on the skin and, consequently, results in minimal scarring.
- Saline implants can be inserted through any incision site
- Saline is “Salt water” which is administered into veins when a person is extremely dehydrated, and thus, it is harmless when absorbed by the body.
- When saline implants are under-filled, there will be swooshing sound just as the one you hear when you are running with a half empty water bottle.
- Saline implants have a 1%/year chance of rupturing/deflating (10% chance after 10 years), and you will know right away when this has happened because your breast will appear deflated, unlike silicone implants which require you to do MRI tests for confirmation of a rupture or gel leakage.
- Saline may not make the breasts feel natural because it is not compressible – there will be a strong resistance when you squeeze your breasts making them feel firm rather than soft and squishy. However, the difference in feel compared to silicone disappears with the amount of breast tissue you have.
- Saline implants have higher chance of rippling (wrinkling) which may be visible if you have less soft-tissue coverage (i.e., soft tissue refers to your skin, fat layer beneath your skin, and the breast tissue). The thinner you are the more you see it. Rippling often develops on the outer perimeter of the augmented breasts: on the side, bottom or in between the breasts. It can be caused by under-filling of the implant. Solutions would be to choose a moderate sized implant, choose behind the muscle implant placement, choose smooth surfaced implant, and gain weight. That being said, only 5% of my patients ever expressed concerns over the rippling, and many do not opt for replacement surgery because it is a minor concern.
- Saline implants are less costly compared to silicone implants
Silicone Implants (5th generation silicone breast implants) - Pros and Cons
- Silicone as a filler will make the implant feel softer resembling the feel of the natural breast tissue due to its gel-like cohesiveness. This characteristic also makes the implants less detectable even by touch or feel.
- Silicone implants are ideal for thin woman with small breasts
- Silicone implants experience minimal rippling which is barely visible and may occur mostly when patients lie down on their breasts
- Silicone’s cohesive gel allows more a greater variety of implants – i.e, shaped implants are only silicone-based and provide a natural look which is helpful in treating certain conditions related to the chest wall or breast development.
- Silicone implants have a 1%/year chance of rupturing similar to saline implants (10% chance after 10 years), however, the rupture is silent which means that you will require an MRI test to diagnose the gel leakage/rupture unlike saline implants, which cause the breasts to deflate making you aware of the problem right away.
- Unless they are small, silicone implants can more safely be introduced behind the breasts through the inframammary or peri-areolar approach compared to the transaxillary appraoch.
- Silicone implants are more costly
- Silicone implants appear in pre-filled form which means implant insertion requires a longer incision on the skin, and its volume cannot be manipulated.
- There is often a concern over safety and monitoring, but silicone implants have a similar complication compared to saline implants, and several clinical trials have shown the safety and longevity of silicone implants that allowed them to be approved by the FDA since 2006.
Hope this helps.
700cc augmentation realistic through transaxillary incision?
This is a very large volume implant, and putting it through the axilla would be very difficult. I would not recommend either this size, or approach.
Dr Steve Merten, Sydney, Australia
Breast Augmentation/Breast Implants/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision
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Incision Route and Implant Size
Thank you for your question. I recommend that you meet with a board certified Plastic Surgeon in person to discuss your goals and be examined/measured. Your surgeon will let you know what size options are reasonable and safe for you and what incision routes you may consider. If you are set on the trans axillary route and a large size, you may need to consider Saline rather than silicone gel implants for optimal results. It will be best to discuss your concerns in person during consultation.
All the best
Is 700cc augmentation realistic through transaxillary incision
Large Implants via a Trans axillary incision
Trans axillary incision for breast augmentation is typically used for smaller silicone implants or saline implants which can be larger because they are filled after insertion. I think your chance of complications will increase trying to place a 700cc silicone implant via a trans axillary incision. I would recommend a consult with a board certified plastic surgeon and to try on implants. I like using the mentor sizing system which gives an excellent representation of what you will look like after the surgery. Focus on the look you want more than a specific bra size. As bra sizes can vary among designers. Make sure your surgery is performed by a Board Certified Plastic Surgeon
Best of luck
Raymond Jean MD
Board Certified Plastic Surgeon
Bryn Mawr, Philadelphia, PA