Breast augmentation transaxillary refers to the creation of a hidden incision at the deepest skin fold of the armpit, thus allowing the surgeons to propel implants into the breast pocket.
Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley says breast augmentation transaxillary is one of his favorite incision techniques, along with the peri-areolar method (or “through the nipple”), due to the well-concealed scar.
Aside from the well-concealed scars, Dr. Smiley says the incision technique offers other advantages such as perceived lower risk of infection, implant contamination, nipple numbness, and breastfeeding difficulty.
The benefits of this technique stem from the fact that the implants will not pass through the milk ducts, which are known to harbor staph bacteria.
But as with any breast augmentation technique, Dr. Smiley says the ideal candidate candidate should have aesthetic goals and breast anatomy that are in line with what the transaxillary incision can accomplish.
- Women whose breasts are relatively symmetric and perky.
Since there is no direct incision on the breast, there is no way that the surgeon can elevate or transpose the sagging breast tissue. Hence, the technique is only reserved for women whose pre-existing bosom has a relatively good shape and projection.
Meanwhile, patients with sagging or pendulous breasts and those with deformity (e.g., tubular or torpedo breasts) are not good candidates for the “through the armpit” technique.
- Patients who asking for moderate-sized silicone implants or saline implants of any size (provided they are within the breast/chest dimension).
It is important to note that silicone implants are always prefilled, while saline implants are propelled into the breast pocket empty (they are rolled up like a cigar) before they are inflated with sterile saltwater.
Hence, extra large silicone implants (or 600 cc and higher) require longer incision than that of saline implants, which of course makes it difficult or even impossible to hide the scar within the armpit.
Nonetheless, most patients today prefer silicone implants due to their softer, more natural results than saline implants. For this reason, Dr. Smiley typically uses Keller Funnel during surgery to ensure that the scar remains relatively short and well concealed within the armpit.
Keller Funnel is a disposable device that closely resembles a piping bag. This is used to propel the silicone implant into its pocket with one squeeze and so the implantation process is quicker and less traumatic to the tissue. Furthermore, doctors are able to use a shorter incision with this technique.
- Patients with a strong history of keloids.
Several studies have suggested that darker skin is susceptible to keloids; hence, ethnic patients tend to choose breast augmentation transaxillary since the incision is placed in this hidden area, which is also known for being highly resistant to aggressive scarring.
Aside from ethnic patients, younger women (i.e., Millenials) often find it unacceptable to have scars on their breast and so they typically inquire about the possibility of placing the incisions within their armpit.