Is Transaxillary Incision Possible with Silicone Gel Implants?

HI, I would like to get 250cc-300cc MAX moderate profile silicone cohesive gel implants under the muscle, but I would like them to be placed through the TRANSAXILLARY incision. I have heard this is not possible, is that true? If not then I'd probably rather saline since I hate scars on the breasts but would like them to feel natural. I am starting out with a full A cup. What should I do??

Doctor Answers 10

Yes it is possible and it is the best way to do it!

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Axillary (armpit) incision has been my favorite approach for breast augmentation for almost 20 years. It is a great procedure if performed with a help of an endoscopic camera. Although for years it has been restricted to saline implants, thanks to a simple device - Keller funnel (introduesed 4 years ago),  it became my favorite procedure for silicone implants as well. If the surgeon is skilled enough to predictably perform endoscopic axillary breast augmentation - it is the best choice - leaving no scars on the breasts, minimal bruising and recovery and minimal injury to the breasts and nipples (breast feeding). After performing thousands of axillary breast augmentatons I have never encountered a bad scar in this region. I cannot say that about inframammary approach

Despite the criticism of people who do not know how to perform these surgeries it has minimal immediate and long term complication rate

Transaxillary Incision

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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 28 reviews

Is Trans-axillary Incision Possible with Silicone Gel Breast Implants?

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This is a great question as there is a common misconception that only saline implants can be used for trans-axillary breast augmentations. The vast majority of the time I use silicone implants for my axillary breast augmentations.

I have placed implants as large as 700cc in through the axilla with the use of the Keller funnel. The funnel allows the implant to go in though the axilla easily and smoothly. Patients should not limit what implant they would like to use because of the incision that they want for their breast augmentation.

Many patients that chose to have a axillary breast augmentation want it because it will conceal their scars and give them a very natural appearance. The use of silicone implants aids in giving patients the most natural appearance possible.

If you are interested in an axillary breast augmentation with silicone implants please see a board certified plastic surgeon with experience in the procedure as they will be able to help guide you!

Yes, it is

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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.

Absolutely! Transaxillary approach with highly! cohesive Natrelle 410 or Sientra implants is the only way to go!!

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Absolutely! Transaxillary Subfascial approach with highly cohesive Natrelle 410 or Sientra implants is the way to go!!!


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.

Transaxillary incision for silicone cohesive gels

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Transaxillary is one approach to place breast implants and was popular with saline implants because the incision could be kept small. With silicone gels the incision has to be longer and with cohesives even longer still.  I would suggest a different approach.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Possible is not always Best

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Trans-axillary implant operations have a higher rate of problems including poor implant positioning. They have a higher redo rate and are really best for saline implants if they are to be used at all.

John P. Di Saia, MD
Orange Plastic Surgeon

While it is possible, you should consider the risks

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It is a bit more difficult but possible to place silicone implants through an axillary incision, but it is important to understand a few things about this approach:

1) Probably the biggest risk of this approach is malposition of the implant. What this means is that the implant may not be placed exactly where the surgeon wants it to be. The aesthetic portion of the breast that is the most important to patients and the most critical to get exactly right (cleavage line and area closest to the center of the chest) is the furthest from the incision with this approach, therefore the risk of the pocket not being created exactly symmetrically or the implant sitting a bit funny in that pocket is higher. Now, this risk is low in the hands of a good surgeon, but the risk still exists.

2) If you need a revision for any reason at any point in your life (the implant ruptures, moves, capsular contracture, etc) it is very difficult if not impossible to perform this revision through the same incision, which means you will end up getting an incision on the breast that you were trying to avoid. The chance of needing a revision is low, but not zero, and the younger you are, the more likely it is that you will need something done with your implants at some point in your life.

3) Finally, there are some studies that suggest that trying to introduce a silicone implant through a tiny incision, such as those in the axilla, can cause small injuries to the wall of the implant. Over time, this may cause a weakening of the implant wall and eventually a rupture. I think this is one reason why many plastic surgeons would not attempt to place the silicone implant through an axillary incision, but different surgeons have different experiences with this, and some may feel that the risk of injury to the implant is no different.

All that being said, I think the axillary approach is a good option for certain patients, particularly those who want modest sized saline implants and fully understand the risks I outlined above. Beyond that, there is some debate as to whether or not it is worth trying to place a silicone implant through this incision.

Hope that helps and good luck!

Dr. S

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

With the right surgeon

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It is possible to place silicone implants through the transaxillary incision but make sure and discuss with your plastic surgeon what would be required if you needed a seconde (not highly likely) operation for a complication such as a hematoma or implant malposition. In some cases a second incision on the breast may be required but the board-certified plastic surgeon that you choose should be able to answer these questions for you.

Dr Edwards

It is possible

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Depending on the skill of the surgeon, you will need a smaller or larger scar to place the silicone implants. In fact, the axillary incision was originally designed for someone like you with relatively small breasts that might not have a clearly defined inframammary fold and whose nipple areolar complex is too small for a silicone gel implant placement. Perhaps your surgeon does or like this approach or diesn't have experience. Soem surgeons prefer this method while others try to avoid it since the approach doesn't allow as much control or visibility.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

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.