Breast augmentation is the concept of placing an implant behind a woman’s breast to make it bigger. It may be conceptually simple but it involves numerous variables which can influence the aesthetic outcome. Every women has to make a choice between the type of implant (saline vs. silicone), size of the implant, which location of the incision to place it through and whether its anatomic location. (submuscular vs. subglandular)
Some of these breast augmentation choices, however, do influence others. The most common one is the incision options for saline vs. silicone implants. Because silicone implants are prefilled, they require larger incisions and historically could not be placed through the more remote incision location in the armpit. Conversely, saline implants are filled after they are in place which makes them easy to insert in a rolled up configuration through the armpit. Besides a lower cost, the armpit incision was often a compelling reason for the use of saline implants because it could be done in a ‘scarless’ manner.
The introduction of the Funnel insertion device for silicone breast implants has changed that traditional thinking. Shaped like a pastry bag, a silicone implant is slipped into the bag and then ‘squirted’ through a small incision into the breast pocket. The implant slips through the small hole at the end of the funnel due to a slippery inner lining and the more even distribution of pressure across the implant caused by the ‘funnel effect’.
The Funnel device has made it possible to use smaller inframammary incisions for silicone gel breast implant insertion. This then brings into play the transaxillary (armpit) approach for silicone breast augmentation. A 2.5 to 3 cm axillary can be used just like for saline implants. The Funnel not only makes it possible to get a silicone implant through the armpit but also prevents it from touching any axillary skin which is probably more contaminated due to its hair content than any breast incision site.
While silicone breast implants can be done in a ‘scarless’ fashion with the Funnel, there does appear to be an implant size limitation. I have found that it can be successfully done up to about 400cc to 450cc of implant size, but beyond that the traditional length of the axillary incision is too small for the implant to go through even with the Funnel. This will vary based on the size of the patient. The implant limit for small women may be 350cc or less while larger women may be able to go as big as 500ccs.
Scarless breast augmentation is now possible with silicone implants. Delivering the implants with a Funnel through the armpit leaves no scar on the breast while the patient can enjoy all the benefits of a softer feeling, longer lasting silicone breast implants. (including even the gummy bear breast implants)
Dr. Barry Eppley
Indianapolis, Indiana