All surgical interventions, including plastic surgery, come with the cost of scars. Breast augmentation is no different. But many women seeking an aesthetic improvement on their breasts are not happy at the idea that they will bear the signs of undergoing surgery on their breasts permanently, so they look for alternatives that will leave the least amount of scarring. The trans-axillary incision for breast augmentation is sought after by many patients as it is a technique that will leave no marks on the breasts as the incisions are actually under the arms and barely visible. But how effective is this technique and can we use it if the patient has breast sagginess too? What is the trans-axillary approach? The insertion of a prosthesis by the axillary approach was developed by Dr. Troques, a French surgeon. It is still practiced today by some plastic surgeons, even if it is not as popular compared to the periareolar or inframammary approach. As is the case with all incision types, it has certain advantages and disadvantages and the patient should be well-informed before making a decision. Advantages of the trans-axillary method – The scar left after the procedure is usually not very long (can be as small as 4 cm) and it is positioned under the arms in a very discreet position. When the arms are not lifted, in most cases it is impossible to see the location of the scars. – The nipple and areola complex will not go through sensitivity changes because they are not injured during the intervention. – Breastfeeding is in most cases possible after the procedure as the milk ducts are not sectioned. Disadvantages of the trans-axillary incision: – The technique is sometimes referred to as the “blind method” as the plastic surgeon has little visibility when performing the procedure. This can frequently lead to breast asymmetries and also excessive bleeding due to the injury of important blood vessels. – If a complication occurs, the plastic surgeon will perform an incision on the breasts to remove or replace the implants. – Only saline solution implants or silicone implants up to a certain size can be used for this type of augmentation. Big silicone implants will not fit. – The recovery time might be longer after this type of incision. – The technique can insert implants, but it can’t correct breast ptosis. Breast ptosis and correcting methods Even if the trans-axillary approach has been used for many years now, it is difficult to find a plastic surgeon that performs it routinely. The number of surgeons performing it has decreased with the development of other techniques (periareolar and inframammary fold) that have more benefits and fewer disadvantages. An important reason why this specific approach should be avoided is the ability to use it to correct breast sagginess. I had patients coming to the clinic with severe breast sagginess and also having breast implants introduced through the armpit incision. They wanted to have the trans-axillary incision because they wanted to avoid scars on the breasts at all costs, but the implants only accentuated the sagginess so now they need a breast lift, an intervention that will leave scars on the breasts. In my experience, many women who undergo a breast augmentation through a trans-axillary incision end up with scars on the breasts eventually, usually after a revision surgery. Sagginess of the breasts is not a complication of the breast augmentation procedure, but something that occurs naturally with the passing of time. So if you have your implant surgery in your late 20s, you might need a breast lift by the time you are 50, especially if the breast implants are significant in size. And this is when you will get scars on your breasts. Moreover, the implants can’t be replaced or removed using the same incision points, like with periareolar and inframammary fold incisions. Plastic surgeons that perform this type of procedure usually focus on this procedure alone as it requires a certain medical device to be performed. This means that they will recommend it whatever your level of breast ptosis might be. You can even see this when checking online for before and after pictures performed with the trans-axillary incision. If the patient had breast sagginess prior to surgery, you will notice how the breasts are even lower on the chest after the procedure. The trans-axillary incision can’t be used to correct breast ptosis as what actually happens during the procedure doesn’t affect the mammary tissues. The plastic surgeon digs a tunnel going from the arm pits towards the back of the mammary gland, and the implant is placed in a pocket created there. This is why there is no damage done to the breast tissues and also the reason why the sagginess won’t be affected in the slightest with the procedure. If you are counting on breast augmentation (more specifically the implants) to do the trick and lift your breasts while proving the desired augmentation, you might be in for a disappointment. If the breast sagginess is moderate or severe, it can’t be corrected without surgical excision. Conclusion As is the case with any surgical approach, the trans-axillary incision technique used for breast augmentation has certain benefits and disadvantages. The main benefit and the reason why it is still performed is the fact that it doesn’t leave any marks on the breasts. The scars are under the arms and barely visible if the patient doesn’t lift her arms. One of the most significant disadvantages entailed by the method is that it can’t correct breast ptosis. If additional revision surgery procedures need to be performed, they will need an incision on the breasts, either periareolar or in the inframammary fold. It is important to be informed of what a technique can and can’t do for you before making a decision to undergo surgery.