Dr. Hughes: So, Dr. Hughes again here. This is breast aug.
[inaudible:00:00:05] today. The first two were transumbilical. This will
be transaxillary. So, this will be a silicone placement. If you notice
over on the side, the incision, I marked them standing up, so that I'll
put the incision behind wherever their arm would normally rest when
they're standing or sitting. So, I'll make the incision below here. I'll
make it as small as possible, about that long. Dissect up under the
pectoralis, make sure the pocket is adequate, place the implant, and
then do the same thing on the other side.

Table up a little more. Good. Okay. So, here's the pectoralis major that
I have in my hand. The attachment is going to the humerus, and here's my
previous incision. So, what I do is I just lift up and place this
incision below, where I have marked, so that the scar won't be
noticeable. Now, she wanted a very large implant. So, ruler. Ruler. So,
it's always important to be mindful of what you need. You need at least
five centimeters to even have a shot of getting in this larger implant.
So, that's what I made, a five-centimeter incision. Then, I'm going to
deepen that. Give me a light. Then, I'm going to go and stay superficial
here, as I get over to the pectoralis major muscle. You definitely don't
want to be in the axilla on these cases where nerves, blood vessels,
lymph nodes . . . You don't want to be into any of that.

So, give me a [inaudible 00:01:59]. Once again, just show where we are.
Army navy. Okay. So, basically we are now right under the pec. Here's
the pec. Okay? So, that's how you know you're in the right plain, and
then you're just finding the pec. border and dissecting underneath it.

Male Voice: Hey, doc. We did this surgery nine months ago. We need new
clearance. No?

Dr. Hughes: Doesn't matter. Doesn't matter.

Male Voice: In labs?

Dr. Hughes: No.

Male Voice: Annie, what are you up to?

Dr. Hughes: She's filming. Genius. You're interrupting my filming. So,
now I'm bluntly separating the pec. major from the pec. minor. Could you
give me a larger retractor. Give me the long Bovie tip. Give me the Army
Navy. Army Navy. You don't need to hold this because it's a tiny
incision. Can you hold it? Table up. That's good. Okay. So, I can see
the fibers of the pec. minor that are still down on the chest wall. So,
that's one good thing. She has some attachments here that I'll just free
up with the Bovie.

I'm dissecting medially and anteriorly. Just kind of feeling, you know,
how big my pocket is. That feels like a pretty good so I'm just going
look back inside and see if there's anything else I need to release
superiorly, particularly in the medial aspect. That looks good. I can
feel that border. That looks good. Give me some irrigation. Okay. You
can stop.

So, this completes the transaxillary augmentation. As you can see,
[inaudible 00:08:56] improvement in overall ptosis. The gap in the
middle has been substantially reduced. It's a nice, natural contour with
kind of a fullness to it. The incisions are closed, as you can see.
They're basically not noticeable from any angle.

Transaxillary (armpit) Silicone Breast Augmentation

Dr. Kenneth Hughes demonstrates a breast augmentation technique that involves inserting the implant through a small incision made just under the armpit of the patient.