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What woman doesn’t want to have fuller, more shapely, sexier breasts? That’s why breast augmentation surgery is one of the most commonly performed cosmetic surgery procedures. There is nothing worse than a nice pair of breast implants, but with tell tale signs of this surgery by having large and unnecessary scars of the breast.

The main reason why women choose to have an axillary approach (through the armpit) to breast augmentation is to avoid any scarring on their breasts. To perform this delicate surgery successfully, Dr. Richard A. Joseph the world renowned Cosmetic Surgeon, uses a small telescope attached to a video camera called an endoscope.

The endoscope has a magnifying lens at one end along with a light source. There is a small camera at the other end. This allows the surgeon to actually view the surgical site from a small axillary incision. The camera enlarges the tissue so the surgeon has a clear and precise view to perform the surgery. According to Dr. Joseph, “The endoscope allows me to view the undersurface of the breast and perform the surgery without disrupting the anatomy of the breast and therefore reduces the chance of excessive scar tissue, the loss of nipple sensation and feeling, difficulty with breast-feeding, and possible problems with mammograms.”

“Through the axillary incision, we are able to place the implant under the muscle and the breast tissue is not disturbed at all. With the patient sedated and under the care of an anesthetist, a small incision is made in the armpit. If you look closely, there are multiple small creases in the center of the armpit where the hair pattern is.” says Dr. Joseph.

“We use one of those creases to place the incision. After a few months, even if my patient’s arms are elevated the scar is nearly invisible.”

Through this tiny incision, the implants are inserted in a pocket that is created behind the chest wall muscle. In doing this surgery it is necessary to release some of the attachments of the chest wall muscle. There are always blood vessels in this area. The endoscope allows excellent vision and control of these vessels while the muscle is being released. Other techniques that do not use the endoscope may result in higher post operative complications.

At surgery, sizers, which are temporary implants, are inserted and inflated to determine what the best size and shape is for the patient. The sizer is then removed and the permanent implant is inserted and inflated. The pocket incision is then closed with absorbable sutures.

Sizers are used to avoid the situation of placing an implant that is either too big or too small for the patient. During the consultation process photos are taken and reviewed with the patient. Patients are also asked to bring in photographs of breasts that they like. Also during the consultation process, patients are measured and fitted for the appropriate sized implant. Frequently, computer imaging is used when appropriate.

Utilizing all these techniques, enables the doctor and patient to go into surgery knowing exactly what size implant she wants. It’s extremely important that the patient, along with her significant other, discuss with the surgeon their desires for her new breast size and shape. “Spending considerable preoperative time with my patients, has resulted in very few of my patient’s begun unhappy with her ultimate breast size,” says Dr. Joseph.

Surgery patients are discharged home wearing a light stretch bra. Most patients are able to return to home or work activities within a few day and selected athletic activities within a few weeks.

Any woman who desires larger, more shapely, sexier breasts are potential candidates for this procedure. For women with sagging breasts, that is if the nipple is below the level of the breast crease, will usually, need either a breast lifting technique or a breast augmentation performed through another incision site.

While not a perfect procedure, Dr. Joseph’s technique for breast augmentation provides the overall majority of his patients with an attractive soft natural breasts with a rapid, problem free recovery.

Richard A. Joseph, MD
Midwest Surgical Arts
1250 North Mill St. Ste 103
Naperville, IL 60563

(630) 717-8200 | MyCosmeticSurgeon.com

Editor’s Note

Dr. Richard A. Joseph selected this article for publication based on its relevance to minimally invasive advancements in cosmetic breast surgery. The insights presented highlight the axillary approach to breast augmentation—performed through a small incision in the armpit using endoscopic guidance—which offers patients a discreet, scar-minimizing alternative to traditional techniques. By preserving breast anatomy and enabling precise implant placement, this method reduces complications and enhances natural outcomes. The article also emphasizes the importance of personalized consultations, temporary sizers, and imaging tools to ensure optimal size and shape selection. This information provides valuable guidance for individuals considering breast enhancement and reflects the evolving standards of modern aesthetic medicine.