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Breast augmentation remains as one of the top cosmetic plastic surgery procedures in the country. The use of a breast implant is a very successful and rapid method of getting breast enlargement due to the immediate placement of the implant device. Getting the implant in place, however, requires an incision somewhere to introduce the implant through into the breast pocket.

Scar free breast augmentation refers to using an incisional approach off of the breast. This is most easily done through the axillary (armpit) region. There are natural skin creases in the armpit (scars always are less conspicuous and heal better when placed along a skin crease) which make placing an incision easy. Also the armpit lies immediately beneath the outer edge of the pectoralis muscle where is where you want to be for breast implant placement anyway.

A very small one inch (2.5cm) incision can be made immediately below the edge of the muscle in a skin crease. Because of this s

mall size, saline breast implants must be used as they are inserted deflated. Meaning they are rolled up like a burrito, inserted through the incision and under the muscle, and inflated after being in position through a long detachable tube. Because of this small incision size, it is not possible to use silicone gel implants because they are bigger being prefilled from the manufacturer. (it is possible to place silicone implants through this incision but it must be made much bigger…as pectoral implants are placed through this same incision)

While there is another non-breast incisional approach to use, the belly button or umbilicus, this requires dissection up through the abdominal tissues which creates pain at two sites rather than just one. I see no advantage to the transumbilical approach over the transaxillary approach.

Scar free breast augmentation has been possible for some time using an axillary incision. Dissolveable sutures are used to close the incision and there is no wound care afterwards. One can shave and use deodorants one week after surgery. The armpit scar heals so well that it is virtually impossible to detect in most patients within months after breast augmentation surgery.

Dr. Barry Eppley

Indianapolis, Indiana

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