PR50 TANSAXILLARY ENDOSCOPIC BREAST AUGMENTATION
Authors: Codner M. A. , Weinfeld A. B. 
Published: April 2007

Transaxillary endoscopic breast augmentation is a very attractive option for women who desire increased mammary volume and projection but do not want a scar on their breasts. For primary augmentations, the procedure offers advantages over the traditional blunt axillary technique due to direct visualization and precise pectoralis muscle dissection and hemostatis. While the technique has been performed for submuscular and subglandular placement, the procedure has been most commonly used over the past decade with saline implants in the submuscular position. Smooth and textured silicone implants can also be used via transaxillary access into a subpectoral location. The results have been satisfactory with improved placement and a reduction incomplications associated with traditional transaxillary augmentation including hematoma, capsular contracture and implants which are positioned too high.

Methods  Transaxillary endoscopic breast augmentation was performed under general anesthesia with the patient in a prone position with arms are abducted to ninty degrees. Local anesthesia with epinephrine was injected into the axillary incision and in the soft tissue overlying the anterior axillary fold for hemostasis. A 2–3 cm incision (4–5 cm when silicone implants are used) was placed in the axilla in one of the natural folds within the hair‐baring zone. Dissection was carried out infero‐medially until the lateral edge of the pectoralis major was identified. Under direct visualizaion, the pectoralis fascia was divided with scissors and the subpectoral space entered. The subpectoral pocket was initially created bluntly with an Agris Dingman retractor to create a bloodless optical cavity without avulsing any muscle. The endoscope and retractor were inserted and the undersurface of the pectoralis muscle was divided with the Bovie electrocautery. The infero‐medial quadrant of pectoralis muscle was partially released from the chest wall. The prepectoral fascia, however was preserved to prevent synmastia, inferior implant migration and palpability. Pocket irrigation and hemostasis were performed. When saline implants were used, the device was rolled, inserted and inflated to the desired volume. When silicone devices were used, the tunnel was bluntly widened with Ashe forceps. A marcaine pain pump can be placed in the pocket for postoperative pain control.

Results  Over 12 years 384 primary breast augmentations have been performed using this method by the senior author. Over 90% of the implants were Mentor smooth round saline implants. The average patient age was 30. High or excellent levels of patient and surgeon satisfaction was present in over 95%. Complications requiring re‐operation were present in less than 2% of patients. The rate of long‐term revision was capsular contracture in 5%. The most common cause of revision was asymmetry or desire to be larger.

Conclusions  Transaxillary Endoscopic breast augmentation is an attractive option for the primary breast augmentation patient which avoids placement of a scar directly on the breast. The advantages are for patients with no ptosis or inframammary fold within which to hide the scar or breasts with a small areolar diameter. Additional advantages include controlled and precise surgical dissection and hemostatis which have reduced the complications associated with traditional blunt transaxillary techniques. Potential disadvantages may include the need for a second inframammary scar if reoperative surgery is required, theoretical interference with sentinel lymph node dissection if required in the future, and the additional technical equipment required to perform the procedure.