Axillary endoscopic breast augmentation: processes derived from a 28-year experience to optimize outcomes.

[BACKGROUND] The axillary approach for breast augmentation has been an option for patients and surgeons for three decades. This article reports a 28-year experience with axillary subpectoral and submammary breast augmentation, and defines proved processes and surgical techniques that have evolved during that experience.

[METHODS] From 1977 to 2005, 690 patients aged 19 to 64 years (median age, 31 years) chose the axillary augmentation approach for breast augmentation. Eighty-four patients had implants placed in the retromammary pocket location, 294 patients had partial retropectoral placement, and 312 patients had dual plane placement. Preoperative planning and implant selection after 1993 utilized dimensional and tissue-based processes published in this Journal.

[RESULTS] Using optimal published processes and instrumentation via the axillary approach, surgeons can deliver equally aesthetic results with equal recovery, reoperation rates, and complications compared with every other incision approach. Refinements in surgical techniques and instrumentation enable patients to predictably experience 24-hour return to normal activities after axillary subpectoral or submammary augmentation.

[CONCLUSIONS] The axillary incision approach for retromammary, partial retropectoral, and dual plane augmentation is an option for patients and surgeons who wish to locate the incision off the breast. Optimal outcomes and 24-hour recovery require a specific surgeon skill set, dimension and tissue-based preoperative planning, and implant selection, defining the desired level of the inframammary fold using proved processes and optimal instrumentation and minimizing tissue trauma and bleeding by implementing proved processes described in this article.