Surgical Approaches to Breast Augmentation: The Transaxillary Approach.

The transaxillary approach to breast augmentation has the advantage of allowing breast implants to be placed with no incisions on the breasts. There has been a general perception of a lack of technical control compared with the inframammary approach. This article presents the transaxillary approach from the perspective of the technical control gained with the aid of an endoscope, which allows precise creation of the tissue pocket with optimal visualization. The aspects of technique that allow optimal technical control are discussed, in addition to postoperative processes that aid in stabilizing the device position and allow consistent and predictable outcomes.

Transaxillary endoscopic silicone gel breast augmentation.

Following the return of silicone gel breast implants to the US market in 2006, augmentation with these implants has become increasingly popular. Surgeons have an array of refined techniques from which to choose when performing these procedures, many of which offer the advantage of reduced or less-obvious postoperative scarring. For obvious reasons, many patients are requesting placement of the implants through incisions that are removed from the breast area (and thereby hidden). The challenge of these approaches is to provide a level of technical control that matches what is afforded with the traditional inframammary approach. The addition of endoscopic assistance has provided a level of tissue visualization and technical control not previously possible with the transaxillary approach, with results that rival those of an inframammary procedure. In this article, the author presents his current operative technique, which has allowed for the routine placement of silicone gel breast implants through a transaxillary incision using endoscopic assistance.

Two-stage expander implant reconstruction: recent experience.

BACKGROUND: Two-stage tissue expander/implant breast reconstruction has become increasingly popular, but reports have varied widely in the incidence of complications associated with this approach. A large consecutive patient experience using low-height tissue expanders in immediate breast reconstruction is presented and discussed in conjunction with other recent reports using this approach following mastectomy. METHODS: A total of 172 consecutive patients underwent immediate breast reconstruction following mastectomy, with placement of a total of 246 tissue expanders. All expanders used were McGhan Style 133LV or Mentor Low Height Contour Profile devices. No patients had preoperative radiation to the mastectomy site. All devices were placed in a submuscular pocket, with the base of the device in a subcutaneous plane in the area of the inframammary fold. Patients either completed expansion with permanent implant placement or had a complication requiring implant removal or replacement. RESULTS: The overall complication rate was 10.5 percent. The most common complication was infection (4 percent), followed by malposition (3.5 percent), rupture (1.7 percent), extrusion (0.6 percent), and capsular contracture (0.6 percent). Patients with malposition, rupture, and capsular contracture underwent replacement with a device of the same type. Four patients with infection required device removal; one underwent delayed device replacement. CONCLUSIONS: Low-height tissue expanders can be used in a consistent and predictable fashion in two-stage expander implant breast reconstruction, with complication rates comparable to those seen with moderate and full-height devices, and without limitations based on the type of permanent implant planned or the breast type to be reconstructed. Recent experience has shown that, while surgeons may prefer different expander device heights, the most important points are consistent use of expander devices with integrated ports, initial placement beneath the muscle, and tissue release to the subcutaneous plane in the inframammary fold area.