Is an Endoscopic Breast Augmentation Better Than the Standard Incision?

By the Get Clear Beauty editorial team · Published October 25, 2026 · How we research pricing

The honest answer is no. An endoscopic breast augmentation placed through the armpit has not been shown to be better than the standard incision in the fold under the breast. The published evidence supports a narrower claim, which is that it performs no worse than other incisions in experienced hands. What the armpit approach offers is a different trade, with real advantages and real costs on both sides, and the patient who understands that trade is in a better position than the patient who is handed the stronger marketing claim.

That caution is not hedging for its own sake. Almost every favorable number published for this operation comes from single-surgeon case series written by surgeons who champion the technique. There is exactly one randomized trial in the area, and it compared the endoscope against the blind version of the same armpit operation rather than comparing the armpit against the fold. There is no randomized trial of transaxillary versus inframammary breast augmentation at all. Every number below carries that limitation with it.

Dr. Goretti Ho Taghva joined the Get Clear Beauty Podcast to walk through the procedure. She is a plastic surgeon and the founder of LEA Plastic Surgery in Newport Beach, Orange County, which she says she founded about eight years ago. She did her undergraduate degree and medical school at Brown and her plastic surgery training at USC. LEA is her three daughters’ initials, and she notes that people often call her Dr. Leah, which is not her name. Her stated philosophy is subtle and quiet plastic surgery rather than loud and exaggerated, and she says the last few years have been hard to watch in Newport Beach, where she thinks the look has become saturated and some patients are now frightened of plastic surgery because of what they see around them.

This post stays on the armpit approach. For implant types, how long implants last, lifetime monitoring and the risks common to any augmentation, read what is the difference between breast implants and augmentation alongside it.

What is an endoscopic breast augmentation?

The incision sits in a natural crease in the armpit. The reasoning is the same reasoning behind the standard approach, which hides its scar in the fold beneath the breast, and both are attempts to place the scar where a crease already exists.

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Dr. Taghva’s argument for moving the incision is worth stating precisely, because it is stronger than the version usually repeated. Nearly every patient has a fold under the breast. In a young, taut or very flat breast, though, that fold can be shallow or sit high on the chest, and the implant itself lowers the fold once it is in place. An incision placed on a shallow or high fold can therefore finish up sitting on the breast rather than hidden beneath it. That is the real case for the armpit, and it applies to a specific group of patients rather than to everyone.

The armpit sits further from the breast than the fold does, which is why she uses a camera. A camera is not a requirement of the operation. The classic transaxillary augmentation dates from the early 1970s and was performed blind, by feel, and blind transaxillary augmentation is still performed today, which is precisely why her best question for a prospective surgeon is the one further down this page.

All three implant positions can be reached through the armpit, above the gland, under the fascia and under the muscle. A published series of 1,389 endoscopic transaxillary cases placed implants in the subfascial and submuscular positions. The technically hardest part is creating a true dual plane from the armpit, which requires releasing muscle along the fold from across the chest. In the randomized trial, two patients operated on with the blind technique needed revision specifically to create a dual plane the first operation had not achieved.

Her incision measures 3 to 3.5 cm. She described a textbook figure of 5 cm, and that needs correcting, because there is no single textbook number. Classical inframammary incisions are described as 3 to 5 cm, and a cadaver study that scaled incision length to implant volume recommended 3.5 cm for 300 cc, rising to 5 cm for 800 cc. A 5 cm incision corresponds to a much larger implant than most patients receive. Her 3 to 3.5 cm against a stated maximum of 550 cc is tight against that guidance, which tells you she relies on an insertion funnel rather than on the opening alone. One systematic review of six studies, none of them randomized, found a pooled relative risk for capsular contracture of 0.42 (95% CI 0.25 to 0.69) with funnel use, and its authors called for a randomized trial to settle it. The funnel is one element of a no-touch routine that also includes nipple shields, pocket irrigation and glove changes, so it is not the whole story on its own.

One piece of dated material still circulates and should be set aside. Silicone gel implants are always pre-filled, while saline implants are inserted empty and filled after placement. The armpit approach became popular during the saline era for that reason, which is why some older sources wrongly state that only saline implants can pass through the armpit.

Is the armpit incision actually better than the fold?

Dr. Taghva says surgeons who do not perform this operation tell patients it is more painful, carries a higher infection risk and produces more scarring. In her own experience she reports less pain, less scarring, fewer infections and less capsular contracture. Her experience is worth hearing, and the evidence belongs right next to it rather than in a footnote.

On capsular contracture, a meta-analysis of seven comparative studies found that the periareolar incision carried higher odds overall, with an odds ratio of 1.83 (95% CI 1.06 to 3.15). Periareolar compared with inframammary gave an odds ratio of 1.91 (1.06 to 3.43), which was statistically significant. Periareolar compared with transaxillary gave an odds ratio of 0.94 (0.52 to 1.64), which was not significant. A 2026 meta-analysis of 22 studies covering 5,843 patients and 11,686 breasts having transaxillary augmentation with silicone implants found pooled capsular contracture of 2.3% (95% CI 1.6 to 3.4), infection of 0.7% and reintervention of 3.3%, and against other incisions a relative risk of 0.73 (95% CI 0.29 to 1.88), which was also not significant.

Read together, those figures say something more specific than most patients are told. The periareolar incision is the worst performer, and the inframammary incision is where that was demonstrated. The position of the armpit incision is genuinely unknown, and the single comparison that exists places it level with periareolar rather than level with inframammary. The familiar ordering, in which periareolar is worst, inframammary best and transaxillary somewhere in between, is not established.

On infection and scarring there is no supporting evidence in either direction. Pooled infection after transaxillary augmentation was 0.7%, while the FDA patient decision checklist lists infection requiring possible implant removal in up to 9% of procedures across all approaches, so those two figures are not measuring the same thing. There is no comparative scar-quality data by incision anywhere in the literature. The accurate statement of the benefit is that the armpit route avoids a scar on the breast, which is real and meaningful, rather than that it produces less scarring overall.

Her claim of less bleeding is her experience and has not been demonstrated. The randomized trial reported zero hematomas in both arms and did not measure blood loss, and in the 1,389-case series hematoma was significantly more common with subfascial placement. Her reasoning on pain is sound, in that the tight pressure patients describe comes from releasing and stretching the pectoralis muscle, and that stretch happens whichever route the surgeon used to reach the pocket. There is still no comparative pain data by incision, and the randomized trial reported no pain scores at all, so treat that as a mechanism worth understanding rather than a number you can rely on.

One mechanism deserves its own paragraph, because it reframes the whole argument. The usual explanation for the periareolar finding is that the incision passes through breast ducts carrying bacteria, so the implant meets a higher bacterial load on the way in. That is exactly the logic critics apply to the armpit, where skin carries a dense resident bacterial population in hair follicles and sweat glands. The pooled data does not confirm the infection criticism. The theoretical basis for it is real, which means the no-touch measures matter more on this route rather than less.

Should you ask whether your surgeon works blind or with a camera?

Yes, and this is the one question in the entire discussion with randomized support behind it. The trial enrolled 118 patients, 59 in each arm, and followed them for one to two years comparing the blind technique against the video-assisted technique.

Only the animation deformity difference reached statistical significance. The authors concluded that surgeons should consider the video-assisted method in order to minimize asymmetries and deformities.

Dr. Taghva’s explanation for why some practices do not offer it is the cost of the equipment, which is plausible and which we cannot verify, so treat it as her account rather than an established fact. Two further questions are worth adding, and she did not raise either. Ask how many of these the surgeon has personally performed, because every published series comes from a high-volume single surgeon and experience matters more here than it does for a fold incision. Ask what the plan is if the operation cannot be completed through the armpit.

Where does the implant sit, and how large can it be?

Dual plane placement is the most common position in breast augmentation today. Dr. Taghva said that nobody performs fully submuscular placement any more, and that is not correct. Total submuscular placement is still used in very thin patients, in revision surgery for rippling or visible implant edges, and in implant-based reconstruction. Her explanation of why it falls out of favor also needs adjusting. The issue is not that the muscle sits high. Leaving the pectoralis origin along the fold intact restricts expansion of the lower pole, so the implant cannot fill the bottom of the breast and the result can look high and flat below.

Placement above the muscle brings less early pain and a faster return to normal activity, which is well accepted. Her figure of most patients back at work a day or two later is a practice observation with no published number behind it, so take it as hers. Her reasoning on tissue coverage is correct, in that the position suits patients who already have breast volume to cover the implant. There is an omission here that changes the calculation, though. Pooled data shows that subpectoral placement carries lower capsular contracture odds than prepectoral placement, with an odds ratio of 0.35 (95% CI 0.25 to 0.50) across 11 studies and 17,707 cases. Choosing the position above the muscle trades less early pain for a measurably higher risk of capsular contracture later, and that trade should be named out loud in a consultation.

On size, the 1,389-case endoscopic series used implants from 180 cc to 800 cc through the armpit, which places her 550 cc ceiling comfortably inside published practice and makes her original 450 cc limit a conservative one. Her description of larger implants as not much more challenging and very safe needs qualifying, because that same series reported an overall complication rate of 6.69%, and large implants carry their own long-term problems whatever incision was used, including tissue thinning, bottoming out and stretch of the lower pole. Size is rarely the deciding factor in choosing this approach, which is a different statement from saying size is not a limitation.

She also referred to a minimally invasive option limited to around 150 cc. She means Mia Femtech by Establishment Labs, which uses Motiva Mia implants with proprietary instruments, and regular Motiva implants go far above that volume. In its 100-patient three-year study, implant volumes ran from 100 cc to 190 cc with a mean of 148.2 cc, so the published maximum is about 195 cc and her figure is closer to the average used than to the ceiling. All 100 patients had implants placed above the muscle. Candidacy is tightly restricted, to patients over 18 with a BMI of 18.5 to 24.9 and a breast width under 14 cm, with no prior breast or axillary surgery, and it excludes drooping or tuberous breasts. The three-year complication rate was 3.2%. That study was funded by Establishment Labs, several authors hold financial ties, and it is a single center reporting 100 patients.

What can go wrong that is specific to the armpit?

Intercostobrachial nerve injury. In the one study comparing approaches, numbness of the upper inner arm and armpit was temporary in 9 of 118 transaxillary patients (7.6%) and permanent in 2 (1.7%), against 1 temporary case (1.9%) and no permanent cases after periareolar surgery. That difference was not statistically significant at that sample size, and the permanent cases were real and occurred only in the armpit group. An inframammary approach does not pass near this nerve at all. Dr. Taghva’s description of the procedure as being performed without damaging nerves cannot be said.

Implant malposition, riding high and bottoming out. Malposition was the most common complication in the 1,389-case series, at 3.64% of an overall 6.69% rate. This is the single most reported problem with the route, and the endoscope is the answer to it, which is what gives the blind-versus-camera question its weight.

Lower pole and fold control. The surgeon releases muscle along the fold while working from across the chest, so an uneven crease between the two sides is a described risk, and revising a fold often requires a fold incision anyway.

The scar, described honestly. The benefit is genuine, because there is no mark on the breast. The scar is still visible. It sits where it shows with arms raised, in a sleeveless top, in a swimsuit and at the gym, and axillary scars can widen, darken, or form a band that tugs when the arm lifts. There is no comparative scar-quality data by incision to appeal to. The fair framing is that this approach trades a scar you might see on your breast for a scar you might see when you raise your arm, and only the patient can decide which she would rather have. Ask to see photographs of healed armpit scars at one year, not at six weeks.

Future sentinel lymph node biopsy. This one is unsettled rather than alarming. Dissecting the armpit raises a theoretical concern about disrupting lymphatic drainage if a patient later needs breast cancer staging. The literature is small, old and inconclusive, with a 26-patient prospective study calling for long-term study and case reports describing successful mapping afterward. It is worth raising with your surgeon, particularly if you have a family history of breast cancer or a known BRCA variant.

Conversion to a fold incision during the operation. Dr. Taghva warns patients during consent that she may convert if the tissue is too scarred or if continuing would risk nerve injury, which is good practice. Published evidence on axillary revision is thin, and the one reoperation in the Mia Femtech study was corrected through the fold. Converting is a normal and acceptable outcome rather than a failure.

One anesthesia detail that belongs to this route. The arms are positioned out to the side, which is part of why Dr. Taghva says the operation adds about 30 minutes, and arm positioning carries its own small risk of positioning-related nerve stretch. The rest of the surgical risk picture, including hematoma, seroma, infection and blood clots, is the same as for any breast augmentation and is covered in our general augmentation guide.

Will it change nipple sensation or your ability to breastfeed?

Dr. Taghva described the effect on nipple sensation as really zero, and that claim has to be corrected. The one study comparing approaches found permanent nipple sensory loss in 12 of 118 transaxillary patients (10.2%) against 3 of 53 periareolar patients (5.7%), with temporary loss in 26 transaxillary patients (22%). The difference was not statistically significant at p = 0.335, and the direction runs opposite to her claim. For broader context, a 2026 scoping review of 37 studies and more than 13,000 patients found persistent nipple sensory change generally under 5%, and a review of 26 studies and 9,190 patients found most changes temporary and usually resolving within 6 to 12 months. The FDA checklist lists skin or nipple areola sensitivity changes or loss reported in up to 35% of procedures.

No approach can promise zero, and the anatomy explains why. The nerve supply to the nipple, chiefly the lateral branch of the fourth intercostal nerve, runs through the pocket the surgeon is dissecting regardless of the entry point. Her mechanical point still holds, because the armpit route does not cut through gland or ducts, and that is a real advantage over a periareolar incision. It simply does not reach zero.

On breastfeeding, implants reduce the odds rather than removing the ability. A 2023 review of 11 studies gave a pooled odds ratio of 0.45 (95% CI 0.38 to 0.53) for breastfeeding across five comparative studies. A 2018 meta-analysis gave a relative risk of 0.63 for exclusive breastfeeding and 0.88 for any breastfeeding, and concluded that a periareolar incision did not appear to reduce exclusive breastfeeding. The FDA checklist lists inability to breastfeed reported in up to 1.6% of procedures. The honest summary is that most women with implants can breastfeed, implants reduce the odds somewhat, the armpit approach avoids cutting the ducts and gland, and no surgeon can promise it will not affect you.

Do implants really need replacing every ten years?

No, and Dr. Taghva is right to say the ten-year rule is outdated. There has never been an FDA requirement to replace implants at ten years. Her follow-on advice, that a clear MRI means you keep going, needs updating, because MRI alone is no longer the schedule.

Current FDA labeling states that for patients without symptoms, the first ultrasound or MRI should be performed at five to six years after surgery and then every two to three years thereafter, and that for patients with symptoms, or with equivocal ultrasound results at any time, an MRI is recommended. Ultrasound is now an acceptable first choice, which replaced the 2006 schedule of MRI at three years. Compliance with that older schedule was under 5%, largely because an MRI costs roughly $1,500 to $2,000 and is generally not covered for this purpose. Saline implants carry no screening recommendation, because a rupture is self-evident. None of this replaces screening mammography.

Implants are not lifetime devices, which is stated in the FDA boxed warning your surgeon will give you on the patient decision checklist. The correct expectation is no fixed replacement date, lifelong imaging, and another operation at some point. So-called gummy bear implants hold their shape because of the cohesive gel, which means a break in the shell does not release free-flowing silicone, and that is exactly why a rupture is usually silent and found only on imaging. Her point that the implant still has to be exchanged is correct.

One practical thing to do on the day. You will receive a patient device card carrying the serial or lot number, style, size and unique device identifier. Keep it somewhere you will find it in ten years, because without it you will not know what was implanted if there is a future recall.

Who is not a candidate for this approach?

Per the FDA, nobody should receive implants while they have an active infection anywhere in the body, existing breast cancer or pre-cancer that has not been adequately treated, or while pregnant or nursing. The FDA also lists a higher risk of a poor outcome for current or former smokers, for patients with conditions affecting healing such as diabetes, lupus or a connective tissue disorder, for patients taking drugs that weaken resistance to infection, and for patients who have had or are planning chemotherapy or radiation. Smoking is the one risk on that list a patient fully controls.

For the armpit version specifically, Dr. Taghva and the published candidacy criteria agree on significant breast droop, because you do not want an implant sitting high with tissue sagging over it, and because significant droop needs a lift, a lift already places a scar on the breast, and the main reason to use the armpit therefore disappears. Significant asymmetry is easier to correct through the fold. Tuberous or constricted breasts, major chest wall asymmetry, prior axillary surgery and complex revision cases also point away from this route.

One part of her pre-operative advice needs correcting. She suggests shaving a few days before surgery rather than the night before, and says waxing works well because it lasts longer. Both the CDC and the WHO advise against removing hair at all unless it would interfere with the operation, and say that if it is removed it should be done with electric clippers, with the WHO calling shaving strongly discouraged at all times and citing a meta-analysis that found lower infection odds with clippers than with shaving, at an odds ratio of 0.51 (95% CI 0.29 to 0.91). Her timing advice is a sensible practical compromise, because a few days allows razor nicks to heal, and razor shaving is still not recommended practice. Waxing causes follicular trauma and can cause folliculitis, so if you prefer it, schedule it well before surgery rather than in the final days, and never on inflamed or broken skin. She also advises no deodorant immediately afterward, which is universally agreed, and the reason is keeping a healing incision clean rather than any demonstrated infection figure. Follow your surgeon’s specific pre-operative instructions over anything written here.

What does an endoscopic breast augmentation cost?

Our published estimates are all-in figures, covering the surgeon, the anesthesia and the facility. Many numbers quoted elsewhere are the surgeon fee only, which is why an honest all-in figure looks higher than the one a patient found before arriving at a consultation.

Her figure of about $15,000 excludes add-ons such as nipple reduction or axillary liposuction. She says it runs about 20% above her own price for an inframammary augmentation, which implies roughly $12,500 for her standard incision, and that the difference reflects about 30 extra minutes of operating time for equipment setup and patient positioning. She notes that the more complicated sterilization requirement falls on the surgery center rather than on the patient. Those figures describe her practice specifically and should not be read as a market rate.

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This article is for general education about aesthetic treatments and pricing. It is not medical advice and is not a substitute for a consultation with a licensed provider. Always confirm current pricing and suitability directly with a provider before booking.