COSMETIC TOWN JOURNAL



Expert Doctor

Inframammary and Transaxillary Incisions for Breast Implants

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Navanjun Grewal, MD

Beverly Hills, CA

Inframammary vs. Transaxillary Incisions

Breast augmentation is unique in that surgeons have four different incision choices, two of which include transaxillary and inframammary. A transaxillary incision is an incision made in the armpit in the natural fold that exists. A channel is then made to the breast and a pocket is made behind the breast for the breast implant. An inframammary incision is made in the fold where the lower part of the breast meets the chest wall. From there, a pocket is made behind the breast for the breast implant.

 

ADVANTAGES OF THESE TWO INCISIONS

  • A transaxillary incision, the armpit incision, potentially leaves the breasts looking untouched. The scar being under the armpit is the main advantage. There are some surgeons that say it is less damaging to the actual breast gland than other incisions. If a patient has had multiple biopsies for breast cancer, she may already have scars on her breasts and may not want any more. In cases like this the patient may request a transaxillary incision. Before that happens, a counseling session would be held on the advantages and limitations of that incision.
  • The advantage of an inframammary incision is that the scar can be hidden by a bra or bikini because it is under the breast for women that have a decent sized breast to begin with. There is also more control over bleeding, more precision, and the ability to make internal modifications as necessary since most women have some degree of asymmetry. In addition, there is no risk of nerve damage to the nipples with the inframammary incision.

When it comes to choosing which incision to use, the comfort level of the surgeon and the type of implant chosen helps determine the incision choice.

 

TRANSAXILLARY INCISION LIMITATIONS

One limitation of a transaxillary incision is visibility in terms of the implant being put in the patient. The surgeon does not have as much control in the positioning of the pocket that the breast implant goes in. The incision size in the armpit can only be so large so it is limited on how big of an implant can be placed. Silicone implants and medium to large implants are very difficult to put in transaxillary incisions. The gummy bear implants cannot be put in because they are directional and the surgeon cannot predict the direction of the implant when it is put into a transaxillary incision.

Another big limitation is the fact that once the transaxillary incision is used, it can never be used again for adjustments to the breast implant. The one incision is all the surgeon gets when placing the implant. If the shape of the breast is not perfect or if something needs to be adjusted, the surgeon will have to make another incision somewhere on the breast whether it is inframammary or around the areola. Transaxillary can only be used once because of the long channel that is created from the armpit to the breast. Once the implant is in there a doctor cannot go through the same channel to try to adjust the implant because there is no space to lower the implant or to move it medially to adjust the skin envelope.

 

INFRAMAMMARY INCISION LIMITATIONS

The main drawback of the inframammary incision is that the incision is in the fold on the breast. Patients might decide years later to change their cup sizes from what they originally picked. If they go much larger, the scar that was under the fold actually starts to go up under the breast because now they have a much bigger breast. On the other hand, going really small makes the scar become visible since the same breast size is not there to hide it. Any revision of the original surgery has a drawback because the scar can move on the breast. The scar will not move if there is no revision surgery performed at a later date.

 

RISKS

Transaxillary incision has a risk if the surgeon is not careful performing the procedure. There can be numbness in the arms or hands because of where the incision is placed since it is close to a lot of nerve bundles. It can be challenging if there is some preexisting asymmetry. It can also be challenging if the surgeon has very little experience with that type of incision because of bleeding and the need to be very precise.

There are very little risks with the inframammary incision. The incision can be made longer to give more visibility and a safer surgery. It can also be reopened for subsequent surgeries.

 

CAPSULAR CONTRACTURE

There is a lot of data on the causes of capsular contracture. There are certain precautions that surgeons need to take when putting breast implants in. Some of the data suggests that an incision around the areola increases the rate of capsular contracture due to contamination as the breast implant touches and glides by the breast tissue since the surgeon has to cut through the breast tissue to get underneath it. Statistically, that significantly increases the risk of capsular contracture.

Thankfully, the transaxillary incision has no increased risk of capsular contracture while the inframammary does have an increased chance.

 

RECOVERY

There really is not any difference in the downtime and recovery period with the different incision types. Traditionally, the surgery can be done through four incision types which are transaxillary, periareolar, inframammary, and transumbilical. In the past, there was a considerable amount of downtime and pain with any of the incision choices. Thanks to proper preoperative planning, precise techniques, refinements in postop carem and intraoperative medications, most patients now return to normal activities within 24 hours. The average return to work is within two to five days.

 

REVISIONS

The majority of patients have revisions for natural reasons. Doctors normally inform patients that they need to have their implants exchanged or replaced every ten years. In that ten year time span, they may have had weight fluctuations or pregnancies where the breasts have gotten larger or smaller. The patients might want to change the appearance of their breasts and have new implants put in. They might want bigger breasts, smaller breasts, or other body procedures like a mommy makeover.

Patients have revisionary surgery mainly for changes in the appearance as well as the shape and size of their breasts. The main reason for revisions is not capsular contracture, deflation, or a rupture of the implant.

 

FINAL THOUGHTS - CONSULT WITH A DOCTOR

Many patients are uneducated on the pros and cons of their incision choices and locations. Before any decisions are made, patients need to be counseled by a surgeon so they are comfortable with the approach decided on by the surgeon. The doctor and the patient also need to discuss the goals of the procedure and how big they want the implants. This is where counseling comes in and why it is the most important part of determining which incision is used. Find a doctor near you and schedule a consultation.

 

Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview with Navanjun Grewal, MD in Beverly Hills, CA