Transaxillary Incision for Silicone Breast Implants?

I want cohesive gel silicone breast implants. I am 12 or 13 inches in diameter and would much rather prefer moderate profile (for full A or small B); I hate the look of the high profile implants. I wouldn't like to increase more than 250- 300cc. I'm very worried about having scars on my chest. I only want the transaxillary incision. I heard that this is not possible with gel implants, but I've seen it done on surgeons' before and after webpages. Any advice?

Doctor Answers 9

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

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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 Silicome Implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The axillary or underarm area incision is primarily used for sub-pectoral ('under the muscle') implant placement, particularly in patients with small areolae (where the peri-areolar incision is not ideal) and smaller breasts (where the inframammary fold is not concealed) or for any woman who wishes not to have scars on the breasts. Silicone or saline implants can be inserted through this incision. Just be certain to select a surgeon with extensive experience with breast implants through the underarm. It is also important to keep this or any scar out of the sun to avoid undesirable scars.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Yes it can be done I do it several times a week

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Transaxillary incision is my preferred way to perform breast augmentation surgery. I have performed thousands of these procedures using saline implants. The problem with silicone implants was solved once the Keller funnel hit the market. This simple device changed the world of breast augmentation. It allows me to insert implants as large as 700-800 cc through the axillary approach safely and expeditiously , And patients have no scars on the breasts, no risk of nipple duct injury or breast feeding problems and usually minimal bruising and recovery. It is a perfect but not easy to perform procedure. You need an expert to make it beautiful and predictable

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

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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!

It is possible to place silicone breast implants via the transaxillary approach

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Yes, it most definitely possible to place your silicone implants through a transaxillary scar. I actually prefer this approach and use it about 95% of the time. We are able to achieve a very natural looking result with a smooth silicone, submuscular implant. Make sure your surgeon is experienced in this method as it is technically demanding when compared to the periareolar or inframammary approach. The scar in your armpits will be the same length as the scar would be for any of the other approaches and will fade nicely. Good luck!

Dr K

Robert M. Kachenmeister, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 28 reviews

It is possible

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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. You may want to research experienced board certified plastic surgeons in your area to see if one can do this for you. Best of luck.

Transaxillary is a great way to insert both saline and gel implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I frequently place gel implant through a transaxillary incision. The only difference from saline implants do this same way is the the incision must be quite a bit longer. Even if you don't make the incision longer it will tear itself. However the incisions all have healed well and a re minimally noticeable. If you are sold on gel implants and I certainly prefer them, then I would encourage you to consider an incision around the nipple areolar complex and place the implants under the breast instead of the muscle. I have found that with the new cohesive gel implants my patients get a better result and a more natural looking and feeling result. You also avoid the movement of the implant when you flex your pectoralis muscles.

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 17 reviews

It is possible

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Depending on the plastic surgeon you can have silicone implants, of any profile assuming they are proportionate to your body, placed via the trans-axillary approach. Do make sure and have a conversation with your plastic surgeon as to whether you would possibly have another incision and subsequent scar should there be a need for revision surgery. Dr Edwards

Transaxillary approach for cohesive gels

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

First of all I am not a big fan of transaxillary implant placement.  Furthermore, using silcione impalnts requires a bigger incision in the armpit than salines, and cohesive gels need a larger incision than standard gels.

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