I have the biggest series in The Aesthetic Surgery Journal for transaxillary augs in September of '11. A transaxillary augmentation is making the incision in the arm pit in the highest axillary crease so it keeps all the scars off of your breast so it makes it look more natural so that if somebody happens to see you in a bathing suit that's riding up, you don't see a scar or if you are intimate, you can't see the scar. Not many people look to the arm pit to see the scar for a breast augmentation. Shifting around of an implant is more of something you have to worry about with a textured implant if it doesn't stick to the tissues, which is the reason why it cuts down on the chance for capsular contracture.

A higher profile implant is one that's a little bit more rounded. If you put that under the muscle and you are using your pec major all the time, that's one thing we saw from the '90s when we used higher profile implants with saline that they would tend to migrate a little bit more to the sides with somebody that had a pectus carinatum that their chest was like stuck out so that the implants would tend to go to the side. If they had a straight chest, they didn't do that as much and certainly if they have a pectus excavatum where they go in, you are going to get a lot more cleavage. I tell patients all the time we haven't figured out how to get water to run uphill yet.

The immediacy of breast implant is pretty quick. Most of my patients the next day are excited just to be able to see the size and the volume, little things change. Obviously the amount of antibiotics that we use in the pocket and the swelling changes and at first the muscle makes them a little bit higher and that may take a good three months for them to drop. They don't drop like this but the center of gravity changes where the upper pole goes in and then the outer pole goes out. You'll have almost your entire result by six months.

Different implants feel differently. The saline implant is a little bit harder than what the silicone would be and certainly it jiggles a little, I'd say more like Bette Midler's boobs. It has little bit more of a water look to it and you'd certainly see more ripples on the side. The silicone, the smooth-walled silicone, if you make a big pocket, moves with the patient. When they lay down at the beach, they fall more to the side. At the beach area, which [inaudible 00:02:41] Laguna beach, you'd probably see, in all of southern California, more use of this smooth-walled implants because they move with the patient a little bit more. The textured devices, I was part of the studies for the 410 implants or textured devices and I use them for a breast reconstruction and for revision and they are a wonderful implant. Everybody has a pro and a con of what they are looking for. Certainly we think that the textured devices are probably going to last little bit longer as well.

What Is a Trans-Axillary Breast Augmentation?

Dr. Daniel Mills explains a trans-axillary breast augmentation and how the various types of implants act differently in the breast pocket.