The axillary breast augmentation approach is recommended for patients with very small areolas (less than 4 cm in diameter) or those who prefer not to use the inframammary fold for the incision.
By choosing the axillary route, patients avoid any scars on the breast. The incision is made in the most anterior part of the armpit to create space for the silicone implant.
Just like the periareolar and inframammary approaches, the implant can be placed in the following planes:
- Below the mammary gland (subglandular)
- Below the fascia of the pectoral muscle (subfascial)
- Below the muscle itself (submuscular or retropectoral)
Advantages and Disadvantages of Each Plane
Option 1: Subglandular Plane
This is the most commonly used plane as it is easier to dissect and allows better control of bleeding during surgery. Postoperative pain and discomfort are minimal and typically last only a few days.
The main disadvantage of this plane is that for very thin patients with little to no breast tissue, the implant might become visible, leading to an artificial appearance or rippling. When there is sufficient breast tissue, these ripples don’t appear. However, for patients with minimal volume, the submuscular placement is preferred.
Option 2: Submuscular Plane
This is the second most commonly used plane. It is ideal for:
- Very thin patients who need an extra layer between the skin and implant to avoid visibility.
- Patients who have experienced capsular contracture in the subglandular plane and need to switch planes.
- Patients with a strong family history of breast cancer or prostate cancer in male relatives (since they are linked genetically). This plane provides a barrier between the mammary gland and the implant, facilitating biopsy procedures if needed.
The downside of this plane is that postoperative pain and discomfort are greater, requiring stronger pain management. Additionally, activity restrictions like driving or exercising last longer.
Option 3: Subfascial Plane
This technique involves placing the implant beneath the fascia of the pectoral muscle. While it offers potential benefits, such as delaying breast sagging due to the fascia’s theoretical support, it is less commonly used in Brazil.
Axillary Approach: What You Need to Know
The axillary approach can be performed with or without video assistance. While some surgeons use direct vision, others opt for a camera and specialized tools to prepare the implant pocket. Both techniques yield similar results, and claims that “video-assisted implants” provide superior outcomes should be approached with caution.
Dr. Alexandre Charão’s Recommendations
- Inframammary Subglandular Implants: Ideal for most patients, especially those with areolas larger than 4 cm and some glandular volume. The scar is almost imperceptible.
- Axillary Subglandular Implants: A great option for avoiding breast scars (even though they are minimal) while minimizing postoperative discomfort and enabling a quicker return to daily activities.
- Axillary Submuscular Implants: Especially recommended for very thin patients or those with a family history of breast cancer.
- Periareolar Implants: While this approach leaves a fine scar around the areola, Dr. Alexandre prefers other techniques that avoid breast scarring altogether.
During your consultation, Dr. Alexandre will evaluate the best approach and placement for your case, considering your preferences and anatomy.
Breast Cancer and Silicone Implants
It’s important to emphasize that silicone implants do not interfere with breastfeeding, regardless of the chosen plane. Additionally, the axillary approach does not impact the sentinel lymph node, which is used to evaluate cancer progression in patients already diagnosed with breast cancer.
Silicone implants also do not hinder breast cancer detection. During mammograms, a specific technique is used to displace the implant, allowing the mammary gland to be fully evaluated without interference.
Anesthesia and Hospital Stay
Local anesthesia with sedation is typically used for breast implant surgery, with general anesthesia rarely required.
Patients can expect a total hospital stay of approximately 8 hours. Thanks to advancements in medicine and Dr. Alexandre’s 15 years of experience, it’s safe and efficient to be admitted at 7:00 AM, undergo surgery between 8:00 and 10:00 AM, and be discharged by 3:00 PM.
Dr. Alexandre Charão’s clinic in Rio de Janeiro offers a comfortable and well-equipped environment for axillary breast implants and other plastic surgery procedures.
