Stephen W. Gordon, M.D.
There has been a recent revival in the news media about breast augmentation with implants being done through the armpit (trans-axillary breast augmentation), or belly button (trans-umbilical). Doing breast augmentations using remote incisions are not new ideas and for the most part, have been set aside by the vast majority of plastic surgeons. The only benefit mentioned by the authors is that there is no scar on the breast. But, there is a scar in the armpit or belly button, and the scar can be visible through normal clothing and at times be unattractive.
The best breast implant on the market today is the Breast shaped silicone implant (otherwise known as an anatomic, teardrop or “shaped” implant). These implants have textured surfaces, are breast shaped and tend to stay in position much better than smooth round implants. These implants can only be put in through the breast fold (and occasionally through areola border) incisions, which usually heal with very minimal scars. If you want a round silicone implant placed through a remote incision, your selection will be limited to the smaller, smooth sizes.
“Scar less” breast augmentation may not be such a great idea. Let’s explore additional reasons why the surgeon should avoid remote incisions.
- You are limited to a smooth round saline or small smooth round silicone implant for armpit incisions. Your only implant option is a smooth round saline implant if it goes in through the belly button. You could put a textured saline implant in through the armpit, but few surgeons rarely use them. Smooth round implant position and movement is difficult to control, and often leads to patient dissatisfaction, and re-operations.
- When remote incisions are used, the surgeon cannot see what he/she is doing as well as they could use a standard breast incision. This means the pocket development will not be as precise. The pocket may be irregular, too big or too small. This can lead to implant malposition or other breast contour problems. Regardless of whether endoscopic instruments are used or not, troublesome bleeding in the pocket can occur and force the surgeon to immediately convert over to a standard breast incision so he/she can see better, and stop the bleeding. This possibility is something the patient must be aware of and agree to in writing prior to any remote incision surgery.
In conclusion, just because you can do something doesn’t mean you should. Be wary of the hype. “Scar less” breast augmentation isn’t scar-less, and it has significant drawbacks including limitations in implant selection and greater risk of beast shape issues