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Combined neurogenic and arterial Thoracic Outlet Syndrome (nTOS and aTOS) is a rare disease. First rib resection with scalenectomy is a mainstay of treatment. TOS results from pathology in the interscalene triangle. Many etiologies were described as its contributing factors, however, to the author’s knowledge, axillary breast implantation had not yet been described. In patients who have mild anatomical pathology, scar formation from axillary surgery may aggravate TOS symptoms. The author wishes to present a case of mild elongated C7 transverse process that then underwent breast implantation, subsequently developed combined nTOS and aTOS, successfully managed through transaxillay first rib resection and scalenectomy.