During the last decades transaxillary breast augmentation (TBA) has gained worldwide acceptance. Breast augmentation via transaxillary access endoscopically assisted in the subglandular, subfascial, and submuscular planes has been previously described. Although transaxillary breast augmentation is a well-studied procedure, few reports exist concerning the subfascial plane of implant insertion and none exist comparing the three different types of insertion by transaxillary breast augmentation.

METHODS:A perspective study to evaluate the outcomes, complications, and patient satisfaction of transaxillary breast augmentation using the three different planes of implant insertion was performed during 2004-2005. Fifty-three patients fulfilled the inclusion criteria. They were randomly divided into three groups corresponding to the three planes of silicone insertion. All patients had texturized silicone implants that ranged from 190 to 300 cc. Overall satisfaction with the breasts appearance after transaxillary breast augmentation was rated on a scale of 1-5, where 1 is poor, 2 is fair, 3 is good, 4 is very good, and 5 is excellent. The evaluation was made at the follow-up times of 6 months and 3 years.

RESULTS: There were 18 patients enrolled for the subcutaneous transaxillary breast augmentation (Group A), 18 for the subfascial transaxillary breast augmentation (Group B), and 17 for the submuscular transaxillary breast augmentation (Group C). Axillary incision-related complications occurred in 9% of the patients and included formation of a hypertrophic scar and small-wound dehiscence. There was no hematoma formation and no case of infection.

There was one patient from Group A, who developed seroma and was treated conservatively. Twenty-seven months postoperatively the same patient developed Baker III capsule contracture, which required silicone implant replacement in the subfascial plane. One case of stretch marks in a young nulliparous woman from Group B did not need treatment. One patient from Group A underwent implant exchange because of implant size dissatisfaction. Three patients in Group C had mild distortion of the implant during pectoral contracture. A meta-analysis of patient satisfaction 6 months and 3 years after transaxillary breast augmentation is presented.

CONCLUSION: Transaxillary breast augmentation provides consistent, satisfactory results with ease of dissection, when properly indicated. Although the subfascial augmentation mammaplasty has all the advantages of the subpectoral and subglandular augmentation mammaplasties and eliminates the disadvantages of increased postoperative discomfort, implant visibility, and distortion, patients of all three groups had similar rates of satisfaction. Further follow-up is needed in order to compare the long-term effects of the three different planes of insertion.

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