Trans-Axillary Implant

Effectively, this is a sub-pectoral implant via a different route.

The pectoralis major muscle forms the anterior wall of the armpit (axilla), and from there its tendon inserts into the upper-mid humerus.

A vertical incision, two inches long, wide enough to accommodate two fingers, is made in the middle of the armpit, and the lower border of pectoralis major dissected away from the overlying subcutaneous tissues. Then by blunt dissection (using the fingers or sweeping with a blunt instrument, a pocket is created deep to the pectoralis major, anterior to pectoralis minor, serratus anterior, and the chest wall.

The prosthesis is placed in the pocket.

The procedure may be endoscopically assisted to ensure exact positioning, but not all surgeons regard this as necessary. It has all the advantages of sub-pectoral implantation and a well hidden scar; it has the disadvantage of difficulty in access should there be complications, and as in sub-pectoral implantation, the lower portion of the prosthesis is not covered by muscle and this approach does not lend itself to the sub-muscular modification.