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Background: The use of the transaxillary (armpit incision) for breast augmentation has been historically limited to the use of saline implants. Because saline implants are inserted deflated, they are rolled into a tight ‘burrito’ and inserted through an incision that is usually no bigger than an inch or 2.5 cms. in most cases. This creates a ‘scarless’ breast augmentation as defined by not having a visible scar on the breast.

The use of the Funnel device for inserting breast implants has created a whole new way of looking at the options. Besides creating a true ‘no touch’ technique for the implant, it has made the use of a smaller incision for silicone breast implants possible. This has now made it possible to use the transaxillary incision for silicone breast implant insertion.

Case Study: This is a 26 year-old female who wanted silicone breast implants but did not want a lower fold incision if possible. She had a small but good breast shape with no sagging or ptosis, an ideal candidate for a transaxillary breast augmentation method.

Under general anesthesia, 3 cm long incisions were made below the border of the pectoralis muscle in a high armpit skin crease. Blunt instrument dissection was used to make the desired implant pockets and air-filled sizers were initially used to check the size and symmetry of the eventual implant positions. After the sizers were removed, a Funnel device was used in which 400cc high profile silicone Sientra implants were easily ‘squirted’ into the pockets. The skin incisions were then closed in two layers with resorbable sutures.

Her postoperative course was typical for any woman that has had a transaxillary breast augmentation. There was upper arm tenderness on movement and upper chest fullness. She was placed on a Rapid Recovery Breast Augmentation program which included beginning arm exercises the night of surgery. By three weeks after surgery, she had a complete recovery with good breast implant positioning and softness beginning to return to the breasts.

The Funnel device now makes it possible to place most ‘standard’ sized silicone breast implants through an armpit incision. It is critical during the procedure, however, that the implant pocket be as perfectly developed as possible prior to insertion. Unlike saline, there is no reversibility and limited capability for additional implant pocket adjustment once the silicone implants are placed.

Case Highlights:

1) The historic restriction of having to place silicone breast implants through a lower fold or nipple incision can now be obviated.

2) Using a Funnel device, silicone implants can be inserted through an armpit incision of under 3.5 cms in length.

3) There are limits of silicone implant size that be inserted through a Funnel using a small armpit incision which has been up to 500ccs in my experience.

Dr. Barry Eppley

Indianapolis, Indiana

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