Endoscopic Transaxillary Breast Augmentation: A Case Series of 1389 Patients

Background Transaxillary breast augmentation offers an advantageous hidden scar compared with other options for implant placement. While first described as a blunt and blind approach, endoscopic technique further refined this procedure to offer surgeons complete control and visualization of dissection. Despite this, breast augmentation is done far more commonly as was initially described over 60 years ago with incisions on the breast that can result in visible scarring. Objectives The purpose of this study was to report surgical outcomes on the largest published case series to date of endoscopic transaxillary breast augmentations. We describe the refinement of surgical technique and statistical analysis of patient outcomes. Methods This study included all patients with breast hypoplasia who chose endoscopic transaxillary breast augmentation from 2006 to 2022 by a single surgeon. All patients were followed for a minimum of 3 months post procedure. Results Overall complication rate in our cohort of 1389 patients was 6.66%. Malposition of implants was the most common complication at 3.13%. Contracture rate was 1.73%. There was a significant increase noted in hematoma rate in subfascial placement (2.11%) compared to submuscular (0.35%) placements (1.76% increase, p-value=0.0000432) and a decrease in implant malposition in the subfascial group (0.42%) compared to the submuscular (3.71%) group (3.29% decrease, p-value = 0.000480). Implant size ranged from 180 to 800 cc and were placed in the subfascial or submuscular plane. While various implant types were used, the vast majority were smooth round silicone implants. Conclusions This study demonstrates that transaxillary endoscopic breast augmentation is asafe procedure with a low risk of complications. The advantages of a hidden scar should be a consideration for surgeons to adopt this technique.