Is It Possible to Virtually Eliminate the Risk of Nerve Damage During Breast Augmentation Through the Armpit?

I am looking for a surgeon who will take all necessary steps to avoid permanent nerve damage to any part of my body during a transax breast aug. Is it possible to assure your patients in good faith that the risk of nerve damage will not exceed the single digit range (i.e., 0.-9.99%) I would greatly appreciate all thoughtful commentary put forth by surgeons specializing in the axillary approach or particularly educated on the topic of nerve damage associated with BAs. Thx!

Doctor Answers 18

Nerve damage in Breast Augmentation

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Breast augmentation through a transaxillary approach carries the highest risk of nerve damage, 15% in the literature than the more common inframammary approach. A periareolar approach has more nerve damage than the inframammary approach. Nerve damage also depends on the size of the implant that you and your surgeon choose. A saline implant trough the axilla is placed in the submuscular pocket empty and would have less chance of nerve damage that a prefilled silicone gel implant.  As board certified plactic surgeons, we all are supposed to do the best we can but no one can honestly tell you there is zero risk of nerve damage. If they do then I would get a second opinion.

Good Luck,

Leo Lapuerta MD

Triple Board Recertified Plastic Surgeon

Houston Plastic Surgeon
4.3 out of 5 stars 48 reviews

Can you "virtually eliminate" the risk of nerve damage in breast augmentation

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Thanks for this second question today.  The risk of nerve damage in breast augmentation is very small and is not specifically related to the incision used, more by the surgeon's technique and the size of the implants used.  The bigger the implants, the more the risk. 

The axillary incision actually carries an additional risk of numbness that the others don't have.  This is from injury to the nerves that branch across the armpit and give feeling to the inner upper arm.  Numbness there is very unpleasant and never happens with the other incisions.

Numb nipple

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Thank you for your post. In general, most women who have a disturbance in nipple sensation, whether it be less (hypo-sensation), or in some cases too much (hyper-sensation), the sensation goes back to normal with 3-6 months. Occasionally, it can take 1 - 2 years to be normal. Extremely rare, the sensation never goes back to normal. This is extremely rare in augmentation alone, more common in lift or reduction but less with a smaller lift like a crescent lift. Signs that sensation is coming back are needle type sensation at the nipple, itchiness at the nipple, or 'zingers' to the nipple. The number of women that lose sensation is much lower than 10%, closer to 1% in a simple augmentation. In some cases the same occurs with contraction where some women have no contraction and some women have a constant contraction of the nipples. Unfortunately there is no surgical correction for this. Massaging the area can help sensation normalize faster if it is going to normalize, but will not help if the nerve does not recover. In women with hyper-sensitive nipples, this will go away with time in most cases. Usually 3 months or so. In the interim, I have them wear nipple covers or 'pasties' to protect them from rubbing. It is unlikely that down-sizing the implant will cause regaining sensation. Down-sizing the implant may cause saggy breasts, however, and may necessitate a breast lift. Physical therapy with de-sensitivity techniques can help with this issue. The Peri-areolar incision is associated with increased risk of nipple numbness due to the fact that the nerve is in close proximity.
Best Wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
4.9 out of 5 stars 42 reviews

I'm afraid it is not possible to completely remove the risk of nerve damage during breast augmentation through the armpit

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Thank you very much for your enquiry, I'm afraid it is not possible to completely remove the risk of nerve damage during breast augmentation through the armpit but this is extremely rare.

Normally, the symptoms of nerve damage do include tenderness in the area and possibly loss of sensation on the inner part of the arm.

There are number of surgeons however who do specialize in this approach and it would be worthwhile discussing with them there experience of nerve damage in the many patients they have treated.

I do wish you the best of luck if you do decide to go ahead with treatment.

Best wishes yours sincerely,

Adrian Richards
Plastic and Cosmetic Surgeon
Surgical Director of Aurora Clinics

Nerve damage after breast augmentation- which incision is best?

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Nerve injury after breast augmentation may lead to nipple  numbness or breast pain. Most often, this is a temporary effect, caused by stretching of intercostal nerves that enter the breast from the side. The periareolar approach probably has the highest rate of numbness because the skin and breast tissue are cut near the nipple. The inframammary approach has a very low risk of nerve injury, because the surgeon is staying below the muscle. With the transaxillary approach, it is possible to cut the intercostobraciail neve that supplies sensation to the edge of the breast and inner upper arm, but experienced surgeons can avoid this by staying just below the pectoral muscle. 

My personal preference is the inframammary approach. It is much more direct than the transaxillary approach. It is easier to shape the pocket for the breast so that the implant doesn;t ride too high. It is invisible in a bathing suit. Also, if your implant must be removed or repositioned, you can work through the same incision. This is much more difficult with a transaxillary incision.

Karen Vaniver, MD
Kennewick Plastic Surgeon
5.0 out of 5 stars 38 reviews

Axillary breast augmentation, New York breast augmentation

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I have been doing axilary breast augmentation for past 30 years, since 1982. I do about 6-8 per week.  I can assure you that I have not had any nerve damage occur as a result of this type of surgery so far. Nerve damage is very rare from this type of surgery if performed by experienced surgeon. Usually saline implants are used as these can be inserted through a very small incision which also reduces any risks of damaging any surrounding tissue.  These surgeries are done on an outpatient basis. Hope this helps 

Helen S. Colen, MD
New York Plastic Surgeon

Breast augmentation incision location

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Anytime you make an incision in the skin you are cutting sensory nerves. It does not matter how you make that cut-laser, scalpel or even a diamond. I assume in your hypothetical you are referring to the nerves that are the sensory nerves of the breast rather than the skin in general. If that is the case it does not matter what the skin incision is (belly button, crease under the breast, armpit or even surprisingly the nipple itself). A study some years ago using sensitive measures of skin sensation like special brushes showed about a 12% decrease in breast sensation no matter what surgical approach was used. That was done shortly after the armpit approach was introduced and disproved the statements made in favor of the armpit approach. In reality nipple sensation comes from the 4th and 5th intercostal nerves that leave the spine and travel along the ribs towards the nipples. At some point they leave the rib to head towards the nipple. Where this take off point occurs governs whether or not nipple sensation will be affected. If the take off point is in the middle of the pocket created by the surgeon to fit the implant the risk of sensory nerve damage goes up. It is the creation of the pocket that damages the nerve in patients with a predisposed anatomy not the skin incision.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Transaxillary augmentation

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A transaxillary augmentation is not my favorite way to go.  No matter what approach there is always a small risk of nerve damage and no  one knows exactly why it happens in the cases that it does occur in..

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

Risk of nerve injury during trans axillary breast augmentation vs. other incisions

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No surgeon, no time,no where can completely eleminate the possibility of nerve injury in any invasive proceedure, no matter how skilled or experienced they are.

Numbness of the nipple/areola ,if it should occur, usually returns to a functional level within a year

Barry H. Dolich, MD (Retired)
Bronx Plastic Surgeon

Is It Possible to Virtually Eliminate the Risk of Nerve Damage During Breast Augmentation Through the Armpit?

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You're probably talking about injury to the intercosto- brachial Nerve while using the transaxillary approach to BA.

That injury risk is negligible in the hands of experienced surgeon in this technique.

Erel Laufer, MD
Dunedin Plastic Surgeon
4.7 out of 5 stars 35 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.