I Want to Up the Size on my Saline Implants, Where Would the Incision Be?

I currently have 420cc under the muscle smooth round saline implants. The incision site was through my armpit. I want to get bigger implants (600 or so) so they project further out more and are closer together. I'm wondering can they remove them and put them back in through the armpit? I DO NOT want to be cut under my breast or nipples uggh! Saline or Silicone indecisive at this point. Thank you! I am 5'7'' approx. 135lbs

Doctor Answers 8

Axillary breast augmentation

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I do not use the infra axillary approach and would not recommend it to patients desiring larger implants as it is not amenable to creating the appropriate pocket or making adjustments. The shape of the pocket cannot be created as effectively to achieve the result you are looking for with the approach you would like the surgeon to use.

Breast Augmentation Revision

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Thank you for the question. 

Yes your revisionary surgery can be done through the same (trans axillary)  incision. Although I understand your concerns about scarring, this  approach would however not be my first choice. In order to accommodate a larger breast implant and to achieve your goals of closer cleavage and more projection,  the breast implant pocket must be adjusted.This adjustment is better done (at least in my hands) through an infra areolar  incision.  The more accurately the breast implant pocket adjustment is made, the better your end result will be and the less chance you will need further surgery.

If you decide on a revisionary  breast augmentation surgery it  will be very important to communicate your goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.

I hope this helps.

Larger Saline Breast Implants Through A Previous Armpit Incision

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Since the incision is an important concern for you, the armpit approach can be re-used and your saline implants exchanged for larger ones. While silicone implants can be placed through an armpit incision, there are some limitations of size. The size you have in now is about the limit for inserting silicone implants using a funnel technique through the armpit. There is no limit of size when it comes to saline breast implants through the armpit.

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Implant exchange

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You can have your implants exchanged through your armpit - but what you don't like about your current implants is one of the common problems with that approach - not having them close enough in the center cleavage area.  You can also choose silicone or saline but silicone can pose other problems with this approach, especially if you choose a larger implant.

Can 600 cc saline implants be placed through an underarm incision?

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Yes,  600 cc saline implants can be placed through an underarm incision, but the devil is in the details.

First, the base width of a 600 cc moderate profile implant is about 14.6 cm and the base width of a 600 cc high profile saline implant is about 13.3 cm.  Stress would be placed on nerves and skin to put in this size of implant unless the patient's breast base width was at least  this large. The pocket could be over-enlarged and implant malposition could occur.

Second, a pocket that will fit a 400 cc implant will not fit a 600 cc implant and will have to be enlarged. This is done by scoring the lining of the existing pocket so it can expand for the new larger implant.

Third, this enlargement will need to be done through the existing under-arm incision which is usually about 2-3 cm.  To do this precisely, it is helpful to use an endoscope to visualize the pocket lining and do a careful opening; the incision would be enlarged to 4-5 cm.

If there is no bleeding that requires access from an incision on or under the breast to control, the new implant can be placed and inflated.  After all, saline implants are inserted collapsed and rolled up so the final implant size is not an issue so far as insertion is concerned.  Now if you were talking about going to 600 cc gel, another order of difficulty would be introduced, and we would be talking about Keller funnels.

Robert M. Lowen, MD
Mountain View Plastic Surgeon
5.0 out of 5 stars 54 reviews

Replacing implants through the axillae

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It is possible to remove and replace implants through your old incision in the armpit. This is much easier to do with saline implants, as they are filled after they are placed in the pocket. You can also place silicone implants through the armpit, but this requires a longer incision and if you should ever have a rupture of the silicone Implant, it might require a incision in the breast crease.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.8 out of 5 stars 46 reviews

Answer to RealSelf.com Breast implant exchange question

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Increasing your implant size can usually be done through your axillary incision.  When larger implants are placed the scar tissue that has naturally formed around your current implants (the "capsule") will need to be released or partially removed.  This capsular release must be done to accommodate the increased size of your new implants.  If the procedure is completed through your axilla, an endoscope may be necessary to allow the surgeon to see the capsule during the surgery.  If you have a capsular contracture (the breast is usually firm) I would generally recommend removal of most or all of the capsule.  Capsule removal is typically done through in inframammary incision, not through the axilla.

Placement of a silicone implant through the axilla could be very challenging.   I generally recommend placement of silicone implants via the inframammary incision.  Consult with a board-certified plastic surgeon to discuss your options.  

Warm Regards and best of luck.

Eric T. Emerson, MD, FACS
Charlotte Plastic Surgeon
4.7 out of 5 stars 29 reviews

Implant revision under the arm

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It is possible to remove and replace your saline implants and replace them through the under arm approach. You can select a silicone gel implant, though keep in mind that the incision may be slightly larger to pass the gel implant, and also consider the hassle factor of monitoring the gel for leaks, and potential for a more difficult exchange there after.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 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.