Endoscopic transaxillary prepectoral conversion for submuscular breast implants

Abstract

BackgroundDuring breast augmentation, the transaxillary approach provides the advantage of allowing the mammary prosthesis to be placed through incisions that are remote from the breast itself, thereby reducing the visibility of postoperative scars. For patients experiencing capsular contracture who do not want additional scars, the previous transaxillary scar can be used for site change and implant exchange.MethodsThis study analyzed 17 patients (34 breasts) with submuscular breast implants with grade III-IV capsular contracture who received treatment from 2010 to 2015. The mean age of the patients was 29 years (range, 20–38 years). The inclusion criterion was a pinch test of more than 3 cm at the upper pole of the breast. Previous axillary scars were used to expose the pectoralis fascia, and submuscular breast implants were removed carefully. The dissection underneath the pectoralis fascia was performed with endoscopic assistance, using electrocautery under direct visualization.ResultsThe mean follow-up period was 14 months (range, 6–24 months). The entire dissection plane was changed from the submuscular plane to the subfascial plane. Round textured gel implants were used, with a mean implant size of 220 mL (range, 160–300 mL). Two patients developed grade II capsular contracture. There were no cases of malposition or asymmetry. Three patients complained of minor implant palpability. None of the patients required additional surgery.ConclusionsEndoscopic subfascial conversion may be an effective technique for treating capsular contracture and avoiding scarring of the breast in selected patients.

Correlation between the inframammary fold and sixth rib: Application to breast reconstruction

“…Three branches of the pectoralis minor muscle are also attached to the third, fourth, and fifth ribs (Kim et al, , ). In addition, because the female breast is important aesthetically, many surgeons operate in a narrow surgical field of view, through the armpit, to minimize incisional scars during breast augmentation or reconstruction surgery (e.g., endoscopic or robotic surgery; Park and Sim, ). Therefore, it is difficult to determine IMF position clinically.…”

Reoperative Transaxillary Subfascial Breast Augmentation and Fat Grafting: Technical Highlights and a Step-by-Step Video Guide

“…Although the transaxillary technique is well described, 1–23 previous reports concerning secondary transaxillary procedures are limited, 15,18,19 and no previous technical videos have described transaxillary HBA in a reoperative scenario. The secondary transaxillary technique uses the same previous incision, especially because a significant number of reoperations are performed on middle-aged patients, who may be concerned with additional scars and aesthetic outcomes.…”

“…The transaxillary technique for primary breast augmentation has been studied extensively 1–23 ; its principal advantages are the absence of incisions on the breast and the ability to access the different pockets. Although transaxillary techniques have been published in recent decades, concerns have emerged concerning the reoperation scenario.…”

“…22,23,[34][35][36] Furthermore, few studies have offered a technical description of breast augmentation reoperations. 15,18,19 This article and the associated videos provide an outline of the senior author's (A.M.M.) technique for reoperative breast augmentation using transaxillary HBA.…”