Transaxillary vs inframmary incision? (photos)

I have seen my friends inframmary incision scars and I am turned off by them, but not so much that I wouldn't consider it. The fact that transaxillary leaves no scar on your breast is very attractive to me, but it seems like most PS prefer inframmary. Is this because they are not experienced/trained in transaxillary approach? I have two consultations booked, but am afraid that my ps will persuade me towards an inframmary fold incision since its easier. What do you think?

Doctor Answers 13

Inframammary vs. Transaxillary incisions

Thank you for your question.

Choosing the right incision site is important to get the best results.

It is true that most surgeons prefer the inframammary incision, but there are clear reasons for that. However, there are many surgeons including myself who also operate using the transaxillary (armpit) incision and achieve beautiful results for the long-term. So the important thing would be to make sure your surgeon has done many procedures using the incision you want – ask for before & after pictures of your surgeon’s work to determine whether you are comfortable with their artistic work.

Of course, there are many factors that come into play when considering the incision site. They include:

  • Your surgeon’s skill and comfort level in a specific incision approach
  • The degree of visual and surgical control your surgeon will have
  • The ability of the incision to provide access to create and dissect a surgical pocket without much damage to the surrounding tissues (e.g., nerves and blood vessels), and appropriate insertion of the implant.
  • Degree of exposure of the implant to your own body’s bacteria
  • Your preference regarding the final location of the scar
  • Size of the implant


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 best long-term results.

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.

Inframammary (under the breast)

Pros
  • 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


Cons
  • 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)

Pros
  • 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


Cons
  • 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
  • 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

Hope this helps.


Toronto Plastic Surgeon
4.9 out of 5 stars 427 reviews

Fold or armpit

Choosing the best approach to place the implant is a decision that is made by the surgeon but guided by patient preference. Trans axillary augmentation was extremely popular several years ago, but has been abandoned by some surgeons, and used selectively by others - I still perform trans axillary augmentation in patients who's selection of implant size and style are appropriate for this route. There are certainly increased risks of complication when selecting a trans axillary approach- increased capsule contraction rate, increased wound infection rates, and scar widening. Good luck with your consult - 

Arko Demianczuk, MD
Vancouver Plastic Surgeon
4.9 out of 5 stars 11 reviews

Transaxilllary incision is best for you

You don't hide the infra mammary incision by drooping breast and the infra-areolar incision will be visible under your nipple.  After the axillary incision fades, it is a non-issue.  See a board certified plastic surgeon that has experience with all the incisions and he or she will probably recommend axillary for you. 

Daryl K. Hoffman, MD
San Jose Plastic Surgeon
4.6 out of 5 stars 15 reviews

Transaxillary vs inframmary incision? (photos)

Transaxillary breast augmentation was for many years my standard approach. I have essentially abandoned it for two reasons: firstly, patients occasionally complained of the appearance of the scars. They differ from the other augmentation incisions in that they are the only ones that can be visible in public. Many patients have skin types that result in dark scars, at least for a year or two. During this time they may be very reluctant to raise their arms while wearing sleeveless tops or bathing suits. Secondly, and most importantly, it is well established that, at least with silicone gel implants, capsular contracture rates are highest with the transaxillary approach. We are not certain why this is so, but it has been my consistent observation that this is the case. I have used the inframammary approach nearly exclusively for the last 4 years or so, and have had low capsular contracture rates and virtually no concerns from my patients about the scars. Moreover, it is an incision that that can be used over and over, without causing deformity (unlike the areolar incision), and allows access for the surgeon to do just about anything. All the best.

Transaxillary vs inframmary incision?

Thank you for your pictures and questions. Let me first say that in my practice, I use the IMF incision for the vast majority of my breast augmentation. And this is not because I am not experienced or trained in trans-ax approach. I make this choice because I think it is best for my patients. First of all, the majority of patients are choosing silicone implants and these are not to be placed through the trans-ax approach. Second, the IMF approach has the lowest risk of capsular contracture and infection. Third, the IMF approach offers optimal control of the pocket and thus the ultimate outcome of the operation and the result.Don't fool yourself into thinking that we choose something because it is "easy." The reasons we choose things are in the best interests of our patients. Good luck and be safe. 

Inframammary vs transaxillary breast augmentation incisions

There are a variety of reasons why the majority of plastic surgeons in the US prefer a inframammary incision. The most important, I believe, is a diminished rate of capsular contracture and implant malposition when this approach is used. An infra-mammary scar can be concealed in an existing fold beneath the breast. A trans-axillary scar will always be visible, no matter how well it has healed.

Transaxillary vs inframmary incision?

The transaxillary approach has fallen out of favor with most plastic surgeons for three important reasons:Higher risk of infectionHigher rate of capsular contracturesInability to do a true dual plane implant placement (which is the gold standard for excellent results)This does not mean you cannot get an excellent result via the axillary approach, but the statistics are not good. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Transaxillary vs inframmary incision

Transaxillary incisions are popular for the reasons you mention. A limitation of that approach is the potential length of the incision if one is choosing large implants. This does not apply to saline, but to silicone implants. The newer more cohesive gel implants are not as easy to compress as the old ones and, depending on the size and profile chosen, can require an incision that may be too long to place in the armpit.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 26 reviews

Inframammary vs. transaxillary incisions - each have trade-offs.

Inframammary incisions are the most popular and the most versatile. This is particularly true with cohesive silicone gel implants. Understanding the pros and cons of each is important. Plastic Surgeons are trained in different approaches but fewer surgeons continue to routinely perform transaxillary or transumbilical breast augmentation as the focus has shifted towards more customized implant pocket development in the operating room. You appear to be a good candidate for each technique, particularly for modest sized implants. With some implant recommendations the inframammary approach will be preferred. Regards, Dr. Mosher

Mathew C. Mosher, MD
Vancouver Plastic Surgeon
4.7 out of 5 stars 32 reviews

Transaxillary -vs- Inframammary?

Thanks for your question and photos. The axillary approach has been associated with more implant malposition, in part due to using the traditional blunt dissection technique. Many of us now use an endoscopic technique which allows more accurate placement, through visualization of the dissection on a TV monitor. In my experience, good candidates for this procedure are those who have a pre-operative breast shape that does not require manipulation/shaping of the breast tissue itself. This is better accomplished via an inframammary incision. Also, because silicone gel implants are pre-filled, there are some size limitations for successful axillary placement. The best approach will be that with which your surgeon is most comfortable for your particular case. Best of luck to you.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 15 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.