“Scarless” Videoendoscopic Breast Augmentation

Breast implantsare changing the shape of the world. Breast augmentation, also known as augmentation mammoplasty, has been a evolving areas of plastic surgery every year for the past decade. It is one of the most popular cosmetic surgery procedure performed the world over.

Breast augmentation is popularly done through the inframammary (breast fold) / peri areolar (along the junction of the black portion of the nipple with the skin) approach which leave scars on the breast. The Transaxillary Videoendoscopic Breast Augmentation is a technique of breast enlargement where  silicone breast implants are placed through an incision in the arm pit. Most  patients and their partners prefer the armpit incision because it:

1) Avoids scars on the breast : Most patients do not desire to have a scars on the breast, no matter how inconspicuous the scars are.This technique leaves the breast aesthetically intact.

2) Avoids cutting through the breast tissue when placing the breast implants underneath the muscle.

3)The armpit scar heals well. Since the armpits normally remain concealed, the scars are highly inconspicuous, even if they do not heal properly.

In addition, patients who have not had a pregnancy or whose areola is small may not be able to have a periareolar approach for the breast augmentation. Endoscopic transaxillary breast augmentation is ideal for these patients.

The incision is about 5 - 5.5 cms, well hidden in the depth of the armpit. When the incision heals, it is barely noticeable.  A videoendoscope allows the entire breast augmentation procedure to be visualized on a television monitor, while carefully developing the pocket for the implant. As a result the surgeon has total control of the operation and there is no blind dissection of the tissues. The fold below the breast (inframammary fold) as well as the medial aspect of the pocket (the cleavage area)  can be defined precisely. The technique allows the placement of the implants below or above the chest muscle. With the visual guidance of the endoscope, the implants can be placed precisely in the proper position. 

As in all breast augmentation procedures, the operation is performed under general anesthesia. The breast augmentation procedure takes approximately 2 - 4 hours. Patients remain in the recovery for about 2-3 hours after surgery until they are fully awake. Pain with breast augmentation surgery varies from patient to patient but normally lasts 1 to 2 days and is well controlled with pain relief medications. The pain is usually related to the placement of the implants underneath the muscle whether this is done through the armpit, periareolar or crease incision. Thus, the armpit incision is no more painful than the other incisions.

Post operatively the armpit should be washed once a day and antibiotic ointment applied. The stitches dissolve on their own. Deodorant can be used in 2 days. Shaving can be resumed in 2 days with care.The armpit incision is barely seen and blends in with the natural creases of the armpit. Many patients believe that it heals better than the periareolar or crease incision.If a second surgery is necessary to adjust an implant, replace a leaking implant or correct a capsular contracture, this can be done through the original armpit incision. In rare or severe cases, a separate incision on the breast may have to be performed.

One of then potential drawback of the transaxillary incision often cited in literature is the risk of less than perfect placement of the implants. This is attributed to the surgeon working further away from the actual surgical destination, leaving more possibility for error. However, when a surgeon is trained and experienced with the transaxillary technique, the risk of error in implant placement is very low.

Not every plastic surgeon performs the armpit incision for breast enhancement. Transaxillary breast augmentation requires special training, instrumentation and expertise. Your plastic surgeon should be able to perform breast implants through a variety of incisions including the armpit, periareolar or crease incision to give you the most options and can recommend what is best for you, cos at the end of the procedure, its you, who has a scarless breast.