ENDOSCOPIC TRANSAXILLARY SUBPECTORAL BREAST AUGMENTATION

The transaxillary approach to breast augmentation is an established te chnique that offers the advantage of a remote incision in an aesthetic ally acceptable area. The main disadvantage to this approach is the la ck of visualization of the implant pocket, necessitating blind, blunt dissection of the pectoral muscle origins. Occasionally, this limitati on may result in improper implant placement and poor aesthetic results . In order to address this shortcoming, we have explored the use of mi nimally invasive endoscopic techniques in transaxillary augmentation t o allow division of the pectoral muscle origin under direct visualizat ion, effectively lowering the inframammary crease. Initial dissections and instrument development were performed in five unpreserved female cadavers. Subsequently, 103 implants have been placed in 53 patients u tilizing the endoscopic transaxillary approach. Follow-up ranges from 2 weeks to 20 months. There have been no hematomas, infections, capsul ar contractures, or other complications. Aesthetic results have been g ood, and patient acceptance is high. By providing predictable and repr oducible control of the inframammary crease, endoscopic dissection has allowed us to expand our indications for the transaxillary approach t o breast augmentation. Surgical technique and brief clinical experienc e are described.