<\/p>\n
To the unacquainted, breast augmentation may seem like a straightforward procedure with little nuance. But ask a room full of plastic surgeons, and you\u2019ll quickly hear differing opinions on the best way to get the job done. Ultimately, the best approach is what suits your anatomy and goals, which is why consulting with multiple surgeons can help you find the right match for you. While there are several established approaches, one more polarizing option\u2014endoscopic transaxillary breast augmentation\u2014has been catching attention.<\/p>\n
Patients are often interested in transaxillary breast augmentation because the incision is placed in the armpit and, when done well, \u201clooks like not much more than a crease,\u201d notes Laguna Beach, CA plastic surgeon Daniel Mills, MD. This technique \u201cpreserves natural breast anatomy without unnecessary dissections or disruption,\u201d adds Newport Beach, CA plastic surgeon Goretti Ho Taghva, MD.<\/p>\n
That said, some surgeons say the technique is far from their first choice. \u201cMost plastic surgeons will choose an incision in the inframammary fold because it\u2019s easier to see and control what\u2019s happening with the implant and your body, \u201csays Denver plastic surgeon Philippe A. Capraro, MD. \u201cIf you choose to move forward with an endoscopic transaxillary breast augmentation, choose a surgeon who\u2019s comfortable and confident with the procedure.\u201d<\/p>\n
Dr. Mills, who has performed thousands of transaxillary breast augmentations, says one of the biggest limitations is that many surgeons were never trained in the technique and therefore avoid it. \u201cThis is a procedure that is highly operator dependent,\u201d says Dr. Ho Taghva. \u201cIt requires experience, repetition and a thoughtful approach.\u201d<\/p>\n
\u201cIf this is a technique that is of interest to a patient seeking breast augmentation, they should do their research to find the best board-certified plastic surgeon who has significant experience and can show the patient results of surgeries they have performed,\u201d adds Las Vegas plastic surgeon Mike Edwards, MD.<\/p>\n
Ahead, we\u2019re breaking down what endoscopic transaxillary breast augmentation involves, who it\u2019s best for and what to consider before choosing this approach.<\/p>\n
\u201cAn endoscopic transaxillary breast augmentation is a breast implant procedure performed through a small incision hidden in the natural crease of the underarm\/armpit,\u201d says Dr. Ho Taghva. In her practice, she uses \u201ca high-definition endoscopic camera to create the implant pocket under direct visualization, rather than working blindly. This allows me to precisely control the dissection, identify and protect blood vessels and position the implant accurately\u2014all without making any incisions on the breast itself.\u201d<\/p>\n
While Dr. Ho Taghva notes that some surgeons perform this procedure without an endoscopic camera, she and Dr. Capraro think it\u2019s crucial to use one. \u201cPlacing the incision in the armpit drastically impacts a surgeon\u2019s ability to see exactly what they are doing and where the implant is being placed,\u201d says Dr. Capraro, which makes the endoscope essential. \u201cWhen performed under true endoscopic visualization, it allows for precise pocket creation, careful hemostasis and consistent, reproducible results,\u201d adds Dr. Ho Taghva.<\/p>\n
\u201cFor many patients, the biggest appeal is that there is no scar on the chest or around the nipple,\u201d says Dr. Ho Taghva. \u201cThe axillary incision tends to heal very well and is discreetly hidden when the arms are down. As a female, board-certified plastic surgeon, many of the patients who seek me out for this approach value discretion, proportion and long-term aesthetics.\u201d<\/p>\n
Another benefit is that the further away from the nerve to the nipple you are, the less likely you are to injure the nerve, notes Dr. Mills. He also prefers this incision to others because it avoids going through breast tissue, thereby limiting the potential for bacteria to invade the ducts.<\/p>\n
\u201cThis technique works best for patients who already have relatively symmetrical breasts and do not have significant glandular ptosis (breast sagginess)\u2014in other words, patients who don\u2019t require a breast lift,\u201d says Dr. Ho Taghva. \u201cThese are often first-time augmentation patients with good skin quality and well-defined anatomy. Many of the women who choose this approach are very thoughtful about aesthetics. They want a natural, balanced enhancement and are particularly drawn to the idea of avoiding any scar on the breast itself.\u201d<\/p>\n
While Dr. Mills uses this technique almost exclusively, he agrees that it\u2019s best for someone who doesn\u2019t have a really defined inframammary crease or a lot of ptosis. \u201cIt doesn\u2019t keep the breast from dropping off the breast mound, so those people are going to need another incision someday to do a lift anyway,\u201d he explains.<\/p>\n
Dr. Mills and Eugene, Oregon plastic surgeon Mark Jewell, MD note that the treatment is especially popular with Asian women. It\u2019s the most favored incision in Asia because they tend to get more hypertrophic scars, so to avoid clearly visible scars, they often opt for transaxillary implants, explains Dr. Mills.<\/p>\n
Additionally, many patients with athletic or slender body types looking for the refined Pilates or yoga aesthetic seek this approach, says Dr. Ho Taghva. \u201cThis approach is also particularly beneficial for patients who don\u2019t have a well-defined inframammary fold\u2014often because they have very minimal native breast tissue\u2014where an inframammary incision is more likely to heal poorly or result in a visible, unnatural-looking scar.\u201d<\/p>\n
Dr. Edwards says there are good plastic surgeons who can perform this successfully on more complicated patients with asymmetry and some degree of gland laxity, but he notes it should be reserved for experts who perform the technique regularly.<\/p>\n
Dr. Ho Taghva also says those with prior breast augmentation through other incisions would likely be better served with approaches that allow direct access for lifting and revision work. However, if you\u2019re looking to revise a transaxillary breast augmentation, Dr. Mills notes that you can successfully go back through the armpit incision.<\/p>\n
Dr. Jewell names \u201canimation deformity, implant dropout from no IMF reinforcement, the need to wear a compression strap across the upper chest to shove implants downward for four to six weeks and published higher risk of capsular contracture\/infection\u201d as some of the potential drawbacks of this technique.<\/p>\n
Dr. Ho Taghva identifies the main drawback as the procedure\u2019s technical demands. \u201cWhen done without adequate experience or visualization, the risks of asymmetry, malposition or bleeding increase,\u201d she says. \u201cIt requires specialized training, comfort with endoscopic visualization and a strong understanding of anatomy from a remote visual field. Because of that, it\u2019s not widely offered and isn\u2019t appropriate for every patient, particularly complex revision cases or patients who require a lift,\u201d she says.<\/p>\n
Dr. Capraro points to the surgeons\u2019 limited visibility as another issue, adding that complications will be more difficult to access should they arise. The surgeon would also have to be more diligent in creating the perfect implant pocket to prevent movement later on, he adds. Additionally, Dr. Mills notes that with an inexperienced surgeon using this technique, you\u2019re more likely to end up with unevenness in the inframammary crease.<\/p>\n
New York plastic surgeon Mokhtar Asaadi, MD, does not advocate for this approach because the \u201ccreation of breast pocket surgery should be very precise with minimal trauma to the muscle and soft tissues.\u201d Additionally, he says the \u201cimplant should not touch breast tissues and the skin at the time of insertion.\u201d Dr. Edwards notes that lateral or inferior implant malposition and the implant failing to descend properly can also be concerns.<\/p>\n<\/p><\/div>\n