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There are many breast augmentation procedures, however none of them are perfect. The transaxillary submuscular breast augmentation procedure, also known as the Axillary Approach, developed by George Bitar, MD, a board certified plastic surgeon and medical director of the Bitar Cosmetic Surgery Institute, is a controversial technique. The technique involves insertion of saline implants without endoscopy. But the results are said to be far better than other procedures.

Highlights of the transaxillary submuscular breast augmentation
a. This procedure involves the use of anesthesia.
b. The patient asked to stand and the inframammary folds, the superior border of where the implant should lie and the mid line of the breast are marked.
c. After the patient is sedated, a tumescent solution is injected into her breasts.
d. Once the injection takes effect, a 2-cm incision is made in the lower pole of the hair-bearing area of the axilla.
e. Then, with curved Mayo scissors a pocket is made in the axilla and a digital dissection is done to determine an intermuscular plane between the pectoralis major and minor muscles.
f. Once the intermuscular plane is determined, the surgeon uses a blunt, curved dissector to complete the subpectoral pocket.
g. After this, the implant sizers are inserted through the axillary incision and filled to the required size.
h. Once this is done, the back of the table is lifted up so that the patient is in a sitting position.
i. This helps the surgeon to asses the result and make necessary adjustments.
j. Thanks to the tumescent solution, there is hardly any bleeding.

Phase 2 of the procedure
a. The one sizer implant is removed and the axillary incision site is cleaned.
b. With an Army-Navy retractor, an assistant opens the pocket for the surgeon.
c. The air from the saline implant is emptied and it is rolled and inserted through the incision.
d. Care is taken not to let it touch the skin.
e. Once the implant is completely inserted, it is filled with saline.
f. Again the implant is studied with the patient in a sitting position.
g. Then filling tubes are removed, the incisions are closed and covered with flexible skin-closure strips.
h. A foam tape is also put around the breasts so that there is healing in the proper position.
i. The patient then wears a bra and dressings cover the axillary incisions.
j. Recovery time is just 1 to 2 hours.