This is a very common question. The idea of a breast augmentation performed through the armpit is appealing because the scar is well hidden and usually inconspicuous. Unfortunately however there are significant trade-offs with this procedure. In performing a transaxillary (armpit) breast augmentation an incision is made in the armpit and then a pocket is created. Most commonly this pocket is created under the muscle, less commonly the pocket is made under the breast tissue and over the muscle. Usually the submuscular pocket is made bluntly and blindly. This means a blunt instrument is placed through the incision and under the muscle. After inserting the instrument the pocket is created by bluntly tearing the muscle attachments of the pectoral muscle along the inframammary fold and to some degree along the breast bone. It is done blindly meaning the surgeon is not able to visualize the pocket. The pocket is then washed out with sterile saline until the surgeon is satisfied there is no bleeding. The implant is then placed through the incision. Saline implants are the easiest to insert in the pocket as the empty implant shell can be placed through the incision and inflated after it is put in the pocket. Round silicone implants are more difficult to insert. Textured and anatomically shaped implant are not normally used. The downside to this procedure is that the pocket is normally not visualized and less precision in the formation of the pocket can be achieved. This is important because precise pocket creation is an essential step in achieving an ideal aesthetic outcome. Because it is done bluntly and visualization of the pocket is not possible small amounts of blood can remain and possibly lead to a capsular contracture. When the procedure is performed utilizing an endoscope (a device that helps visualize the pocket) some of the problems associated with a blunt and blind dissection are lessened.