Improvements in transaxillary breast augmentation.

[BACKGROUND] Roughly 90% of breast augmentations are done through the submammary approach, yet patients, given the choice, sometimes choose the transaxillary approach, with the inconspicuous scar hidden in the axilla. Because the transaxillary approach is technically demanding and is performed relatively rarely, many plastic surgeons never master the technique.

[METHODS] From 1988 to 2009, 140 patients underwent transaxillary breast augmentation by the author, who developed several innovations and improvements for planning of this operation, its technical execution, and postoperative care. Among these innovations are a new implant selection system, the "boomerang incision," the technique for inserting anatomic teardrop-shaped implants through the axilla, submuscular and subfascial implant placement, a new instrument called the breast implant pusher, and use of intermittent regional postoperative analgesia.

[RESULTS] Implementation of the aforementioned modifications and innovations improved the overall quality and consistency of surgical results. It was proved that anatomically shaped breast implants could be inserted through the axillary incision and correctly positioned in the subfascial and submuscular location. The transaxillary technique is contraindicated for patients with ptotic, asymmetric, or tubular breasts.

[CONCLUSION] Transaxillary augmentation mammaplasty without routine endoscopic assistance is a safe method with predictable results and a high rate of patient satisfaction. The transaxillary technique offers the advantage of locating the surgical scar off the breast. It requires closer supervision during the first few postoperative months compared with the submammary or periareolar technique because it is more difficult to place and maintain implants at the proper level using the transaxillary approach.