Commentary on: transaxillary endoscopic breast augmentation with shaped gel implants.

Abstract

There has been longstanding resistance to the transaxillary approach to breast augmentation because of a perceived lack of technical control. There is a growing body of literature, however, that suggests many of these views may be outdated and inaccurate. In their recent review article entitled “Evidence Based Medicine: Augmentation Mammaplasty,” Lista and Ahmad suggested that either inframammary or transaxillary incisions were preferred for breast implant placement.1 Their article did not distinguish between the endoscopic and nonendoscopic transaxillary approaches. Two single-surgeon, large patient series supporting the nonendoscopic approach have recently been reported by Mills et al and Gryskiewicz and LeDuc and showed low complication and reoperation rates.2,3 Additionally, Gryskiewicz and LeDuc reported higher patient satisfaction scores reported by transaxillary patients compared with inframammary patients.3 To address the need for added technical control in transaxillary breast augmentation, the addition of endoscopic assistance was initially reported by Price et al in a series of patients undergoing saline implant placement in a partial subpectoral pocket.4 Long-term experience has since shown that endoscopic assistance has allowed for tissue visualization and control of creation of the device pocket in a way that matches the inframammary approach in how the partial subpectoral tissue pocket is created in preparation for implant placement.5 Mills et al compared available data on transaxillary breast augmentation outcomes in …