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Advanced Art of Cosmetic Surgery Thomas M. DeWire, Sr., MD, FACS Specializing in Cosmetic Plastic Surgery |
Body Contouring |
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| Breast Augmentation Shape Evolution |
| Shape Evolution and Maturation of the result of Trans-Axillary Breast Augmentation: | ||
| Trans-axillary placement of breast implants is probably the least frequently used technique for enlarging the breasts, but I believe it is the best technique. I feel that breast implants should be placed deep to the pectoral muscle in most patients to avoid interference with future mammography, regardless of age at the time of the surgery. Breast implants placed beneath the muscle, tend to look and feel more natural, have less tendency to develop scar encapsulation (firmness), and are less disruptive to nerves to the nipples and skin, than implants placed above the muscle. Placement of breast implants via the axilla allows the submuscular space to be entered directly, high along the pectoralis major muscles, limiting greatly the dissection and disruption of normal tissues. This approach also prevents any actual contact between the incision and the breast glandular tissue, which may harbor bacteria (Staph. epidermidis ), and thus contaminate the implant, leading to post-op inflammation and peri-implant scar encapsulation. Although it is said by some that Trans-axillary breast augmentation technique leads to too high placement of the implants, that is seldom the case if the implants are placed in a properly developed submuscular pocket. Further, trans-axillary augmentation technique is the only approach that can maintain a completely intact muscle and muscle envelope (fascia) covering over breast implants, without cutting through and then repairing the muscles, thus acting as an internal | bra to support and prevent downward migration of the implants. This muscle envelope, extending downward from the chest muscles to the abdominal muscles, has to be disrupted if breast implants are placed in a submuscular position via either the areola (nipple) incision, or the lower breast skin incision (inframammary fold) approach. This loss of intact muscle support for the implants may lead to the downward displacement of the breast implants over time, leading to the appearance of secondary droop, and "bottoming out" of the implants, causing the nipples to be placed far too high on the breast mound, even slipping up out of a bra or bathing suit top. If a proper submuscular pocket is developed and opened at the time of trans-axillary augmentation mammaplasty, the implants will appear to reside a bit too high at first, but will gradually settle into place over the course of a few weeks, to several months, as the intact supporting fascia (muscle envelope) and the overlying breast skin stretch to accommodate the implants. Representative photos of a patient are displayed at various points in the post-op course, extending out as far as two years, demonstrating this early upper pole breast fullness, and gradual stretching of the lower pole tissues, leading to a very natural result. She rarely wears a bra, and has no tendency to sag now, and most likely will have no tendency to sag far later. | |
Photos Before and After Surgery:
| Pre-op photos of a 33 year old patient with chest wall and breast volume asymmetry. |  |
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| Eight days post-op: Trans-Axillary Breast Augmentation with 375cc implants, achieving a 36C to 36D cup size. |  |
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Note upper pole breast fullness and slight irregularity of the lower breast pole contour due to tightness of the fascia (muscle envelope) and the overlying skin. A small bruise is seen on the breast in this photo at 8 days post -op |
| Three months post-op |  |
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Breasts are still overly round, particularly in the side view, but superior fullness is subsiding, and the lower pole is relaxing. |
| Six months post-op |  |
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Implants continue to settle |
| One year post-op |  |
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Upper breast pole has a natural slope, and the lower breast pole has developed a normal soft curving contour. |
| One year post-op |  |
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Trans-Axillary Breast Augmentation scars are not visible at 1 year post-op in this patient. |
| Two years post-op |  |
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Excellent projection and shape is maintained at 2 years despite rare use of bra support |
| Two years post-op |  |
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Bra allows for deep cleavage |
| Maps to Office | Thomas M. DeWire, Sr., MD, FACS | E-Mail Dr DeWire |
| Advanced Art of Cosmetic Surgery | ||
| 3974 Springfield Road | ||
| Glen Allen (Richmond), VA 23060 | ||
| 804-290-0200 |
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| ©Copyright 1997-2007 Advanced Art of Cosmetic Surgery: Thomas M. DeWire, Sr, MD, FACS Revised: October 29, 2007 04:05:46 PM |