At first glance, it seems like a no-brainer to choose an underarm incision for your breast augmentation, right?  Getting new breasts with no visible scar seems too good to be true.  Well, it IS possible.  But you’ll have to jump through a few more hoops with an underarm incision than with a breast fold or areolar incision. So, the question to ask yourself is: Is is worth it?

Breast augmentation with an underarm incision is a fairly common procedure.  However, it is not the most common way to do breast augmentation.  There are several reasons for this, and I hope that after learning about the advantages and disadvantages, you can make a more informed decision.

The Good News

No Incision on the Breast

The Not-As-Good News

More Swelling, Longer Recovery

Harder to Create the Implant Pocket

Highly Dependent on Technical Skills of Plastic Surgeon

Increased Possibility That Implants May Rise

No Incision on the Breast

The one big advantage of the underarm incision is that there are actually no incisions on the breasts.  So if you want the look of new breasts without the tell-tale sign of surgical incisions, and this is of the utmost importance to you, then the underarm incision is the way to go.

Here’s the skinny on how an underarm incision, or axillary incision in medical terms, works.  I make a an incision in the underarm that is approximately 2 to 3 inches in length.  This is a slightly longer incision than what is made in breast fold and aerolar approaches.

I then create a tunnel underneath the pectoralis muscle that is rectangular in shape.  Then, directly underneath the breast or nipple area, a circular pocket is created for the implant.  The implant is then inserted into the incision and through the tunnel until it reaches the pocket.

Typically, plastic surgeons will only use saline implants with an underarm incision because they are placed into the breast pocket unfilled, which makes it easier to move them through the tunnel.  Once they are in the correct position, the appropriate amount of saline is added to reach the desired volume.  Think of it as added air to a tire or filling a water balloon from the facet.

Silicone implants come pre-filled and are more difficult to fit into a small space.  But it is possible to choose both a silicone implant AND an underarm incision.  More on that in a moment…

But now, for the not-as-good news.

More Swelling, Longer Recovery

The tunnel for the underarm approach requires extra dissection.  And you know what that means – more trauma→more swelling→longer recovery.

With the areola or breast fold incision, there is no tunnel, just  a circular pocket for the breast implant.

Thus, you will typically see more swelling at the top of your breast augmentation with an underarm incision, as opposed to a breast fold or areolar incision.

Typically, it will take 2 to 4 months for most of the swelling to go away with an underarm incision as opposed to 1 month with a breast fold or areola incision.  But  then again, if you can endure a little more swelling in the short term for scar-free breasts in the long-term, the underarm approach might be something to consider.

Harder to Create the Implant Pocket

Because the pocket being created for the implant is further from the incision, it requires a little more work in the operating room to achieve the best pocket.  But, you’ll be unconscious, so this one is really not your problem.

Highly Dependent on Technical Skills of Plastic Surgeon

Despite of what some plastic surgeons may say, it is possible to get a silicone implant through an underarm incision.  The silicone implants do require a slightly wider tunnel and slightly wider pocket or incision to place them.  However, it is possible to do this.  You’ll just need a plastic surgeon with plenty of experience and plenty of skill.

Increased Possibility That Implants May Rise

The tunnel that is created during your underarm breast augmentation will eventually close.  However, it may take 3 to 4 months to fully close.  It is the dedication required during this post-surgical time that usually separates the underarm incision die-hards from the patients who are willing to sacrifice scar-free breasts for a faster and easier recovery.

While the tunnel is open, your breast implants may want to naturally sneak back into that tunnel, especially each time your chest muscle is activated.

When you raise your hands or reach for something or lift a gallon of milk or do a push up, your pectoralis muscle contracts and squeezes the breast implant.  This causes the implant to go towards an open space, which is the tunnel that I have just created.  This is not permanent, but you will have to massage your breast implants down and in to reduce this effect.

With other types of incisions, the breast implants typically require 1 to 3 months of implant massage.  With an underarm incision, you’ll typically need to do 3 to 6 months of massage to reduce swelling and prevent a “high-riding” implant.

To think of it another way, be sure that you’ll be willing to care for your implants every day from Memorial Day to Thanksgiving.  If you are, than you are a good candidate for an underarm incision breast augmentation.  If you’re not, then you’ll still have great looking breasts … with a tiny scar.

Everything in life comes with a trade off.  Breast augmentation is no exception. But, hey, no matter the type of incision you choose – new breasts!

If you’d like to schedule a consultation with Roy Kim, MD to discuss your trade off to new breasts, please contact our Patient Care Coordinator, Caroline, at 415-354-8148.


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