The axillary region is the armpit. An incision placed in the natural folds of the armpit is called a transaxillary incision; many patients believe that a transaxillary incision made during their breast augmentation surgery will be invisible. This is not the case when wearing sleeveless shirts or dresses. These patients are concerned with visible scars on their breasts after surgery but do not mind a visible scar in the armpit region.

Prior to the introduction of endoscopy, once a transaxillary incision was made, the plastic surgeon had to wield a blunt instrument to blindly create a pocket in the breast tissue to hold the implant. With the camera and light on an endoscope, however, the surgeon can easily see inside the body. A channel can be created into the breast, and the implant is inserted into the channel and moved into position behind the nipple. This procedure takes longer than breast augmentation surgery with an areolar incision and complications are different. It is associated with a greater risk of bleeding and drains may have to be inserted, which increases the risk of infection. Due to the location of the incision, lymph nodes may enlarge in the armpit, fluid may collect under the skin in the armpit, there may be temporary or even permanent tingling or numbness in the armpit or upper inner arm and a ridge may form at the scar area that lasts for weeks.  Each scar will be one to one and a half inches long and may be visible when the arm is raised. If a postoperative complication should arise that requires removal of the implant or a revision, the surgeon will have to make another incision around the nipple (periareolar) or in the breast fold on the underside of the breast (inframammary). Using this incision, recovery is about three days, after which the patient may return to work and stitches may be taken out after one week. Exercise is to be avoided for two to three weeks.

The preferred procedure by Dr. Khalifeh is the periareolar or the inframammary incision, although the incision site is determined by the preferences of the patient.  The periareolar incision is made around the edge of the areola where there is a natural demarcation of color.  The implants are then placed under the muscle or glandular tissue. This incision site allows the surgeon close proximity to the area and permits a greater degree of precision.  The periareolar site also allows for a reduction in the size of the areola and a breast lift through the same incision. A periareolar incision site may be used again if there are complications. Potential complications associated with periareolar incisions include loss of sensation in the nipple and damage to the milk ducts which would interfere with breastfeeding. There is an increased risk of a Staphylococcal (staph) infection because these bacteria are found in the milk ducts.

The inframammary incision is located on the underside of the breast where the breast crease at the body wall occurs. This crease is the inframammary fold. The scars will be one to one and a half inches long.  Smaller incisions are possible with saline implants than with silicone implants. Like the periareolar incision, the surgeon is working close to the breast so optimal visibility is afforded. With the inframammary incision, the implant may be subglandular, partially submuscular or completely submuscular.

Call to schedule a consultation to discuss your surgical options at either the Frederick, Maryland or Chevy Chase, Maryland offices at (301) 244-0148. Surgery will take place at Dr. Khalifeh’s accredited Surgical Center or the Sibley Memorial Hospital in Washington, D.C. where Dr. Khalifeh has privileges.