Is Transaxillary Incision Possible for Silicone Breast Implants?

I have consulted several surgeons regarding my Breast implants I plan to receive in November. I was told by 2 that complete submuscular placement can be achieved via the transaxillary, so I had decided to go for it, using silicone, but then was told this approach can not be used with silicone, is this true?

Doctor Answers 13

Silicone Breast Implants are Possible with a Transaxillay Incision

This is a great question you ask. Contrary to the opinions posted above (and I rarely disagree with Dr. Wallach), it is completely possible to place silicone breast implants through an axillary incision. In fact, my opinion and experience is that it is preferable.100% of the silicone breast implants I put in are through the axillary approach.

In considering this question here are a few things to have in mind.

  • Fewer than 10% of augmentations are performed via an axillary approach.
  • Among the advantages of this approach is that there are no vissible scars on the breasts and the axillary scar is extremely inconspicous.  
  • All will agree a silicone implant requires a incision that is longer than that for a saline implant. A question for any patient to consider is where they would prefer the scar; under their breast, around the areola, or concealed in the armpit. I would suggest asking the surgeon to see photo's of results and scars. You will be able to judge for yourself.
  • Some have suggested that the transaxillary approach is not a good choice because they can not do secondary surgeries by this method. This is not the case. Surgeons who are experienced with this method can perform secondary procedures (such as exchanges and capsulotomies) through exactly the same incision.
  • Some surgeons may feel it is too challenging to place a gel implant this way. Not all surgeons are comfortable with every approach. In the end it should be the patient's choice which approach to use but you certainly don't want to ask your surgeon to do something they are not comfortable with.

To answe your question, Yes, Transaxillary Incision is Possible for Silicone Breast Implants.

I hope you find this helpful.


Bernard Shuster, MD

Hollywood Plastic Surgeon
5.0 out of 5 stars 24 reviews

Transaxillary Incision for Silicone Implants

For the addition of a #BreastImplant with a Breast Lift, we have been using an approach for more than 20 years known as the #Transaxillary Breast #Augmentation. Axillary – with this incision, there are no scars on the breasts. Special training, experience, and equipment may be required for this procedure.
It is our most common and recommended site for silicone implant placement.
The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 69 reviews

Axillary Breast Augmentation Truths

Trans-axillary breast augmentation is becoming an increasing popular method for breast augmentation as technology continues to improve. There are several misconceptions about axillary breast augmentation.

First of all both saline and silicone implants can be used with this method. Many patients and surgeons that do not commonly perform this surgery don’t know that a silicone implant can be placed from an axillary incision. The use of the Keller funnel allows a variety of implants to be placed through the axilla easily.

Secondly, the incisions in the axilla is just as small as it would be if it was placed around the nipple or under the breast. The incision is well concealed in one of the natural arm creases in the axilla.

Thirdly the use of the endoscope has made the procedure very precise as the entire breast pocket is created under direct vision. This method has become very popular in Miami where I first practiced and now I commonly perform this procedure here in Austin Texas as it avoids putting any incisions on the breast, thus decreasing the chances of altering nipple sensation.

Please consult your board certified plastic surgeon to help guide you through your breast augmentation process.

Transaxillary gummy bear silicone implants

I place silicone implants through the armpit. I prefer to place textured gummy bear silicone implants through this approach. Many believe it is not possible to do, but I do it regularly. It is my favorite way of performing breast augmentation in patients who are candidates as they have very natural looking results and there is no scar on the breast. 

Luis H. Macias, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 46 reviews

Yes silicone implants will fit through an axillary incision

I use the transaxillary, submuscular approach in nearly 95% of my primary breast augmentations because it hides the scar so well. The overwhelming majority of my patients choose silicone implants because of a more natural look and feel when compared to a saline implant. Yes, it is true that the incision for a silicone implant insertion will be longer than one for a saline implant insertion, but that is true for ALL approaches (including periariolar and inframammary incisions). For an average size implant (350cc) the incision length is usually only one-half inch longer than it would be for a saline implant insertion. That length of scar in the armpit (about 2 inches long) still hides extremely well. When using the Keller funnel. I have placed implants as large as 550cc in a primary augmentation without difficulty. If you choose the transaxillary approach, make sure your surgeon is experienced in this method.

Robert M. Kachenmeister, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 9 reviews


Most surgeons are unable to place silicone implants via the transaxillary incision. This is because silicone implants come pre filled, making it a more complicated procedure to insert and position the implants in the body accurately because of their size. However, I have experience performing this and the rate of satisfaction is high. 

Silicone Transaxillary Breast Augmentation

Yes, transaxillary is a great approach for breast augmentation with silicone implants. The most important choice is actually not where your incision is but who your plastic surgeon is. Pick wisely and choose a board certified plastic surgeon with experience in this approach. See the below link on suggestions on how to choose one.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 99 reviews

Submuscular gels via transaxillary especially with the Funnel

Gels can most definitely be placed via the transaxillary approach.  Salines are definitely easier to place due to the smaller incision  required and a little less dissection under the muscle tails where the implants have to make "the turn."  I have been doing this technique since 1987 and have done around 2500 pairs.  Other than during the "dark days" from 1992-2005, most have been gels.  I used to have a limit of 425 for gels, but with the Keller Funnel I have placed 700's with some room to spare.  The incision is longer but has not been a problem to date.

Myles Goldflies, MD
Bellevue Plastic Surgeon
4.5 out of 5 stars 11 reviews

Silicone and transaxillary appraoch

Silicone implants require a larger incision than saline and therefore may leave an unfavorably long scar in the axilla.

Steven Wallach, MD
New York Plastic Surgeon
4.5 out of 5 stars 22 reviews

Transaxillary silicone gel implants some technical considerations

I agree with your other consultants that transaxillary silicone gel implants are difficult to seat because of the limited incision length. In those patients who are adamant that they must have a "scarless" breast augmentation, I will explain the technical consideration of size, style and texture, which makes the approach more challenging. The endoscope is used to more precisely develop the dual plane pocket but is removed prior to placing the implant, which is limited in its size, lower profile and smooth surfaces.

In my experience, this is a "teaser" fare which can only be used in the first instance. In the event of implant malposition or capsular contracture, another approach must be employed. The scars aren't exceptional and the time for implant settling is generally longer than one of the more direct approaches. Hope this helps.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 55 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.