Is Transaxillary Incision Possible for Silicone Breast Implants?

Question

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?

Johnny Franco, MD, FACS · Answer

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.

Gregory Turowski, MD, PhD, FACS · Answer

As long as your surgeon is skilled in an endoscopic axillary breast augmentation you will be fine. I have performed thousands of these procedures and can assure you this is preferred way to achieve better lookng breasts with no breasts scars. The key is to use an endoscope to visualize the pocket and utilize a Keller funnel to insert the silicone implant See for yourself on before/after pics from my patients

Shim Ching, MD · Answer

A transaxillary approach with submuscular implant placement is entirely possible.  We perform almost all of our breast augmentations in this manner.  A Keller funnel helps immensely in placing the implant through an incision that is high in the axilla and is as short as possible.  A surgeon experienced in transaxillary placement of implants, preferably under endoscopic control should have no problem with this.  Any size of implant can be placed in this manner.Please seek a board certified plastic surgeon that can offer this type of technique for a second opinion.Aloha,Shim Ching, MD

Jed H. Horowitz, MD, FACS · Answer

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.

Luis Macias, MD, FACS · Answer

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.

Jerome Edelstein, MD · Answer

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.

Larry S. Nichter, MD, MS, FACS · Answer

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.

Rian A. Maercks, MD · Answer

The transaxillary approach is very misunderstood.  It is much more difficult and technically demanding then directly accessing the breast through an infra-mammary approach or through the nipple.  This is the main reason that most surgeons think it is too difficult or frankly impossible.  As far as riding high, this is technical error.  The entry dissection through the armpit has to be done thoughtfully.  The lymphatics that drain the breast are nearby and should not be disrupted for the future possibility of cancer staging/lymph node detection.  To avoid the lymphatics, one must stay high and avoid traversing the surgical axilla.  If this is done, there is geometric isolation between the entry dissection and the implant pocket and the implant cannot ride into this area.  The second reason that implants may ride high is that it is more technically demanding to develop an accurate and well designed inferior pocket.  Most of these problems occur when an endoscope is used and the actual placement on the body is overlooked in favor of concentrating on the endoscopic monitor.

	In my opinion it just does not make sense to place a scar on the breast in an aesthetic elective procedure unless a lift is needed.  For primary augmentations with class I-II ptosis I exclusively use the transaxillary Cold-Subfascial Breast Augmentation TM.  What this means is that I access the interface of the pectoral fascia and pectoralis major muscle through the axilla (arm pit) and carefully dissect the fascia from the muscle.  The implant goes under the strong supportive fascia and above the muscle.  This is VERY different from "above the muscle" or subglandular techniques which typically do not fare well.  The fascia not only shapes the breast beautifully but the muscle is out of the picture allowing the breast implant to sit naturally more medially than dual plane techniques and it also offers the implant lasting support to prevent bottoming out and undesirable changes.  Live surgical videos have been published on the technical aspects of the Cold-Subfascial Breast AugmentationTM where the delicate dissection can be observed.

	Even the product representatives may believe that transaxillary placement is too difficult or impossible but these beliefs are remnants from early experience decades ago with saline transaxillary augmentation with a 2-3 cm incision.  The reality is that an endoscope it not necessary and the axillary incision heals and nearly disappears in most women and a larger incision in the axilla can be shortened and hidden with suture technique.

Robert M. Kachenmeister, MD · Answer

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.

Myles Goldflies, MD · Answer

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.

Is Transaxillary Incision Possible for Silicone Breast Implants?

Answers (15)

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