Transaxillary Breast Augmentation
The underarm (axillary) approach to breast augmentation is always the first choice to consider.
I prefer it by far to the other two options (around the areola or in the crease under the breast.
The scar is on a crease in the armpit and will definitely fade better. The incision in the underarm is right next to the edge of the muscle where the implant is going.
The axilla and the lymph nodes are never touched because the surgery is immediately under the skin for the small distance (1-2 inches) the implant will have to go.
The underarm approach is used whenever the breast does not have ptosis. If the breast droops a little, then a “dual-plane” approach from under the breast fold is better.
The areola incision can be a good choice, but I do not use it myself because if the scar should darken unexpectedly it will be front and center. A risk best avoided. (Gregory Diehl, MD, FACS, Long Island Plastic Surgeon)
There are typically 3 incisions used to place a breast implant: in the crease (underneath the breast), under the arm (transaxillary), or along the areola (pigmented skin surrounding the nipple).
The choice of incision is made by both the patient and the surgeon after discussing the advantages and disadvantages of each. (Loren Schechter, MD, Chicago Plastic Surgeon)
Incisions can be made: under the arm under the breast around the areola through the belly button silicone cannot be please trans umbilical. all the incisions are safe and can give equal results when done be surgeons who are experienced with the techniques. problems and complications should be no different (Jed H. Horowitz, MD, FACS, Orange County Plastic Surgeon)
Axillary versus Inframammary Fold Augmentation
This is another personal and surgeon’s preference. My preference is to do primarily inframammary fold breast augmentations as it gives me much more Control especially of a patient with breast asymmetries and minimizes the need for breast revisions which I see often in patients who have had transaxillary breast augmentations. (Rod J. Rohrich, MD, Dallas Plastic Surgeon)
I prefer using the incision in the natural breast crease. This approach allows me to create a sub-muscular pocket for the implant perfectly. This incision heals well and is hidden very easily. Complications i have encountered with this approach are uncommon and/or minamal. (Michael A. Fiorillo, MD, New York Plastic Surgeon)
I am not a big fan of a trans axillary breast augmentation for a couple of reasons. First, I don’t think you can see the surgical field that well. Second, I have seen a number of results which have a poor definition of the inframammary fold near the sternum.
My colleagues that do this surgery will disagree. I respectfully disagree with them. I prefer a small incision under the breast which typically heals to an almost imperceptible result. (Talmage J. Raine, MD, Champaign Plastic Surgeon)
Transaxillary breast augmentation
Breast augmentation can be done in several ways. The most common and popular approach is via inframmary crease line. The second way is through the areola. The third way is through the axilla. The fourth way is through the belly button in case of saline implants. Introducing the implant via crease line or areola offers the most direct way to visualize the implant pocket as well as to place the implant.
However, if your surgoen is well experienced in transaxillary approach, she/he should be able to place the implant without damage to axillary vessesl/nerves/lymph nodes. Please talk with your plastic surgeon to discuss the pros and cons of each approach. (Sugene Kim, MD, FACS, Houston Plastic Surgeon)
Arm Pit Incision is a Safe Choice for Breat Augmentation
Multiple clinical studies from different institution have clearly demonstrated that the arm pit incision does not affect the lymph nodes. This is consistent with my personal experience utilizing this method for years. I have never encountered any issue with lymph nodes. You also ask about swelling. All approaches to breast augmentation will result in some degree of swelling. The thing about swelling is it goes away, its just a matter of time. I recommend my patients have a low sodium diet after surgery and have found this the most helpful thing a woman can do to reduce her swelling. (Bernard Shuster, MD, Hollywood Plastic Surgeon)
As already indicated, this skin incision and approach from the armpit is an excellent route for implant placement. There is no involvement of lymphnodes. A surgeon certified by the American Board of Plastic Surgery who specializes in breast implants and has extensive experience with this approach should be the surgeon performing this or any breast implants.
When performed with an endoscope this technique allows unparalleled visibility for the surgeon to perform meticulous surgery with minimal trauma to your tissues, allowing a rapid recovery after surgery.
This excellent visibility allows reproducible surgery from one side to the other, making perfect pockets. Symmetry is then verified by examining the patient in the seated position at the end of the surgery, checking implant position.
Although less surgeons perform this surgery, it is not because it is inferior to another technique. In fact, the periareolar technique, one of the most common incisions, is associated with the highest rate of capsular contracture, the number one reason for reoperation after primary breast implants.
Plastic surgery is now entering a time of ‘evidence based medicine’, and we will all benefit from performing the best surgeries based on data, not opinion. (Gerald Minniti, MD, FACS, Beverly Hills Plastic Surgeon)
Breast implants incision location
The plane of armpit lymph nodes is deep to the plane through which transaxillary breast implants are placed. This should not be an issue. It is important to decide the route through which breast implants will be placed before surgery however that decision should not be based on your current concerns.
The skin incision should be based on what you and your surgeon are comfortable with and whether or not any skin procedures are required to optimize nipple position. If you need to move the nipple as in a lift it makes no sense to make another incision in the armpit. (Aaron Stone, MD, Los Angeles Plastic Surgeon)
The “transaxillary approach was the “ole” standard in the early 1980’s. I offer this approach as my third alternative to the infra mammary or circum areolar incisions. The reasons are size of incision, effect on lymph glands in axilla, injury to brachial plexus, a blind operation. (Darryl J. Blinski, MD, Memphis Plastic Surgeon)
Transaxillary breast implants considering getting a BA under the arm. Woried about the incision causing damage to lymph nodes as well as swelling. do you recommend altenitives for incision than under the arm?” Most Plastic Surgeons can perform Breast Augmentation surgery through various access incisions and choose each incision to the individual patient’s needs now and in the future.
SOME surgeon perform Breast Augmentation through certain less popular incisions to attract and earn more from the many thousands of surgically-uneducated women who want these scars without a full understanding of all the pros and cons of each incision. The Transaxillary scar is best used in very flat women without any breast tissue (even a breast fold) or those with a very small areola who do not wish to have a breast fold incision.
It is used for other women as well because of surgeon and patient preference by putting a scar at the highest point of the armpit, staying superficial to the lymphatics (but coming close to a nerve providing feeling to the inner arm) and then coming straight to the side edge of the pectoralis muscle where the implant can be placed either over or under this muscle. (Peter A. Aldea, MD, Chicago Plastic Surgeon)
Breast implants with armpit incision
A properly done armpit (axillary) incision will not come close tteh lhe ymph nodes. As soon as the incision is made, the surgeon makes a tunnel to the chest (pec) muscle. The lymph nodes are deeper and in a different direction. Depending on your individual breast shape, other incisions include around the areola and in the crease below the breast. (Karol A. Gutowski, MD, FACS, Manhattan Plastic Surgeon)
This is the most infrequently performed method of breast augmentation due to the limitations of the implants and the limitations to the surgeon.
Silicone Implants can NOT be used with this procedure technique. Saline filled implants are the only option.
The surgeon has a limited amount of control for symmetry and to give the patient optimal results.
In my practice I use the areolar incision sites and most frequently use the infra-mammary fold incision site.
Each patient is evaluated on an individual basis and all the details are discussed prior to the actual surgery. (Rod J. Rohrich, MD, Dallas Plastic Surgeon)
Unfortunately, there are is so much information out there for patients to see, that it can be difficult to determine what procedures actually work and which are more unpredictable.
As the answers from the other surgeons have demonstrated, most of us would not perform this procedure, and some would but only in very specific circumstances when the patient understands the downsides of this approach, which can be massive.
From my point of view, the two big concerns are malposition of the implant and bleeding around the implant. There is simply no way to control bleeding with the TUBA technique that I am aware of.
This blood around the implant can cause anything from significant bruising to long term complications such as capsular contracture and is unfortuantly not something that you will often see discussed on some of the TV shows.
My recommendation to you is to think about what you are gaining and what you are giving up with each approach: With the TUBA, you gain a small scar on the belly button and none on the breast. But, your risk of asymmetry and implant malposition are higher, risk of bleeding around the implant are higher, you cannot use silicone implants, and if you need a revision, you will need an incision on the breast anyway.
With incisions on the breast, you gain a better chance at control and symmetry of the breast pocket, better chance at little or no bleeding or little or no bruising, you can use silicone implants, and you can control the size and symmetry of the areola. All of this, and the cost is a 1- 1.5 inch incision on the breast. (Shahram Salemy, MD, FACS, Seattle Plastic Surgeon)
Belly button breast augmentation: more cons than pros
The reason why it isn’t more popular is because there are significant drawbacks to the method: you can only use saline implants the pocket dissection is indirect and prone to asymmetry it is almost always offered only above the muscle when you need them replaced, you have to go back through the crease or areola; now you have more scars than if you had not gone transumbilical in the first place cannot control bleeding well during surgery because of the remoteness of the incision the implant becomes much more traumatized with this method, and the implant warranty is voided by the manufacturer if this technique is used Bottom line: The only purported advantage of this technique is to have no scars on the breast, but in reality, complaints about the scar through the crease or areola incision are very very rare.
The transumbilical breast augmentation is a solution to a problem that very few patients have, while it generates many more problems than it supposedly prevents. Read the other answers, I doubt my colleagues would disagree. (Lawrence Tong, MD, Toronto Plastic Surgeon)
In general, the farther away from something you are when working on it, the less control you have over it. For this reason, the transumbilical breast augmentation or TUBA offers the least control during placement of the implants. Many plastic surgeons are uncomfortable with this smaller margin of error and unwilling to take the risk. There are a small number of plastic surgeons performing this procedure, but you can likely find one in your area. Make sure it is a plastic surgeon certified by the American Board of Plastic Surgery. (Kenneth R. Francis, MD, FACS, Manhattan Plastic Surgeon)
TUBA is a nice procedure for a straightforward breast augmentation with a saline implant. It does of course leave a significant scar on the belly button, and breast implants can be placed through about a 1 inch incision under the breasts as well, an incision which can be reused for redo surgery. Since most patients have their breast implants redone, and since that cannot be done through the TUBA approach, we don’t see much use for this incision.
I suppose for a patient who cannot tolerate any incision on the breasts, and would rather have a scar on the belly button, it is an option. Nipple areolar asymmetry is often addressed at the time of a breast augmentation surgery. It is of course not fixed with the TUBA procedure. Because of the inability to do revision surgeries, the technical difficulties of surgery (you are far away from the intended surgical site), the inability to correct nipple asymmetries, TUBA is not as popular as it might have been without these limitations. (Brent Moelleken, MD, Beverly Hills Plastic Surgeon)