Most breast augmentation surgeries are performed with the use of inframammary fold technique, which is sometimes referred to as “through the breast crease.” As long as the scar lies within the natural fold of skin or on the underside’s “bulge,” it is barely detectable even when the patient is topless.
Despite the benefits of inframammary fold technique, in some situations it is more ideal to use the armpit incision, or more accurately referred to as trans-axillary breast augmentation approach in which the goal is to position the scar within the underarm crease.
Proper patient selection is the first step to achieve great results from breast augmentation via trans-axillary incision. Women with breast sagging (ptosis), chest wall deformity, or any form of asymmetry are bad candidates for this technique since they require their tissue, ligaments, and skin to be reshaped—something that is not possible if the “access point” is far from the implant pocket.
Simply put, the “right” candidate for this technique should have the “right” underlying anatomies—i.e., no tissue laxity, nipple-areola complex lying above the inframammary fold, and no significant asymmetry. Of course, patient selection also takes into account a person’s motives and expectations from an elective surgery.
To further increase the success rate of this incision technique, some plastic surgeons use an endoscope, which is fiber-optic camera introduced into the body for better visualization. According to studies, the device minimizes the risk of increased bleeding, postop hematoma, surgical trauma, and implant malposition—complications that occur at a higher rate in “blind dissection.”
However, even the most high-tech endoscope (and auxiliary devices used for pocket dissection) is not useful if a surgeon lacks endoscopic skills and a comprehensive understanding of the breast anatomies. For this reason, a prudent patient should make sure her doctor is not only certified by the American Board of Plastic Surgery, but also has expertise on this procedure.
In the hands of a skilled plastic surgeon, the risk of implant malposition with the use of endoscope can be as low as 2 percent, while in blind dissection (without the use of such device) it is estimated to be around 9 percent.
Modern endoscope, which allows for better control and view, has also made it possible to predictably dissect the submuscular implant pocket, thus controlling the amount of bleeding and reducing the risk of postop hematoma or pooling of blood underneath the skin.