Lipo Incision Location

[Octoberman]

Are there any potential problems with incision entry points for lipo being located under arms ( arm pits ).  Most of the surgeons on this site seem to lipo from the side chest wall or thru the aerola.  However, the surgeon that I have consulted with enters under the arm pit ( under arm hair conceals the scar ).....but I am worried that this could cause problems with lymph nodes under arm.  Any thoughts?  Thank you!

[DrPensler]

I think surgeons use incisions that in their experience produce the best results for them. I utilize an incision about 1 to 2 mm in size slightly medial to the insertion of the Pectoralis Major. The insertion of the Pectoralis is the lateral lip of the intertubercular groove of the humerus and the crest of the greater tubercle of the humerus. I also utilize a periareolar incision for gland excision.After gland excision I perform additional liposuction through both incisions.I find these incision extremely difficult to perceive after surgery compared to other incisions which I have used and/or seen. My concern with an incision that would be covered by armpit hair is that it would be next to impossible to have the cannula reach the subareolar area. To be honest I have never heard of an incision in the middle of the armpit in the hair bearing region.

[Octoberman]

Dr. Pensler,

Thank you for your response.  Yes, I have consulted with a couple of plastic surgeons, and this is the only surgeon who has stated that the lipo entry point would be in the arm pit.  The explanation is that the lipo would be completed thru thhis incision, and then an arthroscopy shaver would also be inserted thru this incision to attempt to remove remaining breast tissue.  Lastly, an incision would be placed at the bottom of the aerola to remove any remaining breast tissue directly below the aerola.

My main concern was with the incision under the armpit relative to the underarm lymph nodes.  Not sure if this could potentially harm lymph nodes in this area. 

This plastic surgeon is very big on limiting visible scars, and I believe that this is the reason that he prefers to use the underarm area as an entry point.  As this seems out of the ordinary from other surgeons, it set off some red flags in my mind.  Any advice or opinions are much appreciated.  Thank you!

[DrPensler]

I am always skeptical of someone who has a "secret"technique that only he does etc. I would be more worried about getting into the chest from an incision high in the middle of the armpit with a  cannula not to mention the exponentially decreased  control of the cannula  beneath the breast than damage to a lymph node. I have a series of custom manufactured cutting cannula, but really there is no substitute for a periareolar incision for ease ,visibility and predictability of excision of glandular tissue. To try to remove the glandular tissue from the middle of the armpit and then make a periareolar incision anyway just does not make a lot of sense to me.

[Dr. Elliot Jacobs]

My approach differs slightly from Dr. Pensler.  First, I make a small (4mm) incision on the side of the chest.  This provides an optimal location for me to do aggressive liposuction with cannulas which can remove both breast and fat tissue.  The incision location also works for me ergonomically and it provides access to all areas of the chest and lateral chest (for fat removal there as well). Sometimes I can do the entire procedure through this one incision.  Many times, though, I have to make a peri-areolar incision to complete the removal of solid breast tissue. 

I do not use an incision in the armpit because it requires the arm to be stretched too high and over the course of an operation, could result in some stretched out nerves.

Just my thoughts on the issue.

Dr Jacobs

[Dr. Schuster]

I generally perform the the entire surgery using one small incision (1/2 in) that is positioned towards the side of the chest, but not under the armpit. It is called the lateral pull through technique. I think it would be a real struggle from the armpit.