Axillary vs Inframammary Approach to Breast Augmentation: What Differs

When patients research breast augmentation, two of the most discussed incision approaches are the endoscopic axillary (underarm) approach and the inframammary (under-breast) approach. Both can be used to place breast implants, but they differ in where the incision is made, how recovery unfolds, and which patients are suited to each. This article explains the practical differences.

The inframammary approach: an overview

The inframammary approach places the incision in the fold beneath the breast - the inframammary fold - where the lower surface of the breast meets the chest wall. This fold is a natural anatomical landmark, and when incisions are placed and closed carefully, the resulting scar typically sits within or near the fold and becomes less visible as it matures over time.

The inframammary approach gives the surgeon direct visual access to the pocket where the implant will be placed. This makes it a versatile approach that accommodates a wide range of implant types and sizes, and allows precise control over pocket dimensions. It is one of the most widely used approaches in breast augmentation globally.

The endoscopic axillary approach: an overview

The axillary approach places the incision in the armpit rather than on or near the breast itself. A small incision is made in the axilla, and the surgeon uses endoscopic equipment to create the implant pocket and position the implant under camera guidance.

The primary appeal of the axillary approach for many patients is that it leaves no scar on or near the breast. The scar is located in the armpit, where it is typically concealed within the natural skin folds of the axilla when the arm is resting at the side.

The endoscopic axillary approach requires specific surgical training and equipment. Chirurgia Plastica MD specialises in this technique and offers it as part of its minimally invasive breast surgery programme. A general overview of the approach is available in our post on axillary breast augmentation.

How scarring differs between the two approaches

Scar location is often the primary factor patients focus on when comparing these approaches. The inframammary approach produces a scar in the breast fold - this scar is concealed beneath the breast when standing, but may be visible when lying down or in certain clothing. With careful technique and good healing, inframammary scars can become faint over time.

The axillary approach produces a scar in the armpit, concealed within the natural fold of the axilla. For patients for whom any scar on the breast is an important concern, the axillary approach offers the advantage of keeping the breast surface clear.

Scar healing is individual. Factors including skin type, genetics, post-operative care, and the precision of the surgical closure all influence how a scar matures. No approach can guarantee an invisible scar - this should be discussed honestly at a consultation.

Recovery: how the two approaches compare

Recovery patterns differ somewhat between the two approaches, though individual variation is significant and both require a period of restricted activity. Key differences include:

• With the axillary approach, there may be temporary discomfort or stiffness in the shoulder and upper arm area in the early post-operative period, related to the passage through the axilla
• The inframammary approach does not typically involve this upper arm component, but involves the same general breast recovery - discomfort, swelling, and activity restrictions that apply to any breast augmentation
• Both approaches share the standard recovery considerations for breast augmentation: activity restrictions, implant settling, and a gradual return to normal activity over weeks

Candidacy: which approach suits which patient

Not every patient is a candidate for every approach. Suitability for the axillary approach depends on factors including chest anatomy, the specific implant being used, and the intended pocket position. Some implant types and sizes are more accessible via one approach than the other.

The inframammary approach is generally applicable to a wider range of cases, which is one reason for its widespread use. The axillary approach requires anatomy and implant selection that are compatible with the access constraints of working through the armpit.

Determining which approach may be appropriate for any individual patient is part of what a consultation is for. Neither approach is universally superior - the right choice depends on individual anatomy, goals, and the specific implant plan.

Frequently asked questions

Is the axillary approach as safe as the inframammary approach?

In the hands of a surgeon trained in the technique with appropriate endoscopic equipment, the axillary approach is a well-established and safe method of breast augmentation. The key variable is surgeon experience with the specific technique. It is reasonable to ask a surgeon how frequently they perform axillary augmentation and what their experience with it is. A surgeon who performs the technique regularly will have a more developed understanding of its nuances than one who uses it occasionally.

Will the axillary approach limit which implants I can have?

The axillary approach does impose some constraints on implant selection compared to the inframammary approach. Certain implant shapes and sizes are more straightforward to place via the axilla than others. This is a consideration your surgeon will discuss during the planning phase, and it is one of the reasons why implant selection and approach selection are discussed together rather than separately.

Which approach produces the least visible scar?

This depends on what you mean by visible and in what context. The axillary scar keeps the breast surface clear, which is the priority for some patients. The inframammary scar is concealed beneath the breast in everyday circumstances. Individual scar healing varies considerably. The right answer for any specific patient depends on their anatomy, lifestyle, and priorities - a consultation is the place to work through this with a surgeon who can assess your individual situation.

How do I find out which approach is appropriate for me?

A consultation with a surgeon experienced in both approaches is the only way to get a reliable answer. At Chirurgia Plastica MD, the team has specific experience with the endoscopic axillary approach as part of its minimally invasive breast surgery programme. To arrange a consultation, submit a request through the contact page.