Breast augmentation is far from a one-size-fits-all procedure. While some view it as straightforward, plastic surgeons often debate the best methods, as the optimal approach depends on a patient’s anatomy and goals. One increasingly discussed, yet polarizing, option is endoscopic transaxillary breast augmentation, which places the incision in the armpit rather than on the breast itself.
Why Patients Consider the Transaxillary Approach
Patients are often drawn to transaxillary breast augmentation because the incision is discreetly hidden in the armpit. Laguna Beach, CA, plastic surgeon Daniel Mills, MD, explains that when done correctly, the scar “looks like not much more than a crease.” Newport Beach, CA, plastic surgeon Goretti Ho Taghva, MD, adds that this method “preserves natural breast anatomy without unnecessary dissections or disruption.”
However, not all surgeons favor this technique. Philippe A. Capraro, MD, a Denver-based plastic surgeon, notes, “Most plastic surgeons will choose an incision in the inframammary fold because it’s easier to see and control what’s happening with the implant and your body. If you move forward with an endoscopic transaxillary approach, choose a surgeon who’s comfortable and confident with the procedure.”
What the Procedure Involves
Endoscopic transaxillary breast augmentation uses a small incision hidden in the natural armpit crease. Dr. Ho Taghva describes using “a high-definition endoscopic camera to create the implant pocket under direct visualization, rather than working blindly. This allows precise control, identification of blood vessels, and accurate implant positioning—all without incisions on the breast.”
While some surgeons perform this technique without an endoscope, Drs. Ho Taghva and Capraro emphasize that visualization is crucial. “Placing the incision in the armpit drastically impacts a surgeon’s ability to see exactly what they are doing,” says Dr. Capraro. Endoscopic guidance ensures precise pocket creation, careful hemostasis, and consistent, reproducible results.
Benefits of the Transaxillary Incision
The main appeal is cosmetic discretion. “There is no scar on the chest or around the nipple,” says Dr. Ho Taghva. “The axillary incision heals very well and is discreet when the arms are down.” Dr. Mills adds that the technique reduces the risk of nerve injury and limits bacterial exposure because it avoids dissecting through breast tissue.
Who Is an Ideal Candidate?
Dr. Ho Taghva explains that the procedure works best for patients with symmetrical breasts, minimal glandular sagging, and good skin quality—often first-time augmentation patients seeking a natural, balanced enhancement. Dr. Mills notes it is less suitable for those needing a breast lift, as the technique does not prevent sagging over time.
The approach is particularly popular among Asian women, who are more prone to hypertrophic scars, and among athletic or slender individuals seeking a refined, natural look. Experienced surgeons, like Dr. Edwards, can also perform it on more complex patients, but this should be reserved for experts.
Potential Drawbacks and Risks
While the technique has aesthetic advantages, it is technically demanding. Risks include implant malposition, asymmetry, and potential complications like capsular contracture or infection. Dr. Jewell cites possible “animation deformity, implant dropout, and the need for prolonged compression therapy.” Limited visibility during surgery means that any complications may be harder to address, according to Dr. Capraro.
Surgeons like Dr. Asaadi caution against this approach, emphasizing that breast pocket creation requires precision, minimal trauma, and avoidance of contact with breast tissue during implant insertion. Improper execution may result in uneven inframammary creases, lateral or inferior implant malposition, or incomplete descent of the implant.
