title: Transaxillary endoscopic breast augmentation with shaped gel implants.
abstract: BACKGROUND
  At its inception, transaxillary breast augmentation was a blind technique associated with complications and unpredictable outcomes. The transaxillary approach now involves electrocautery dissection with direct endoscopic visualization and yields excellent aesthetic outcomes with a concealed scar. Shaped implant devices can be combined with transaxillary augmentation for natural-appearing results that can be individualized to the patient.
  
  
  OBJECTIVE
  The authors sought to improve the results of transaxillary endoscopic breast augmentation by placing shaped gel implants in patients with an indistinct or absent inframammary fold (IMF), who wished to avoid a breast scar.
  
  
  METHODS
  One hundred sixteen Asian women underwent transaxillary endoscopic breast augmentation with electrocautery dissection and were evaluated in a prospective study. A partial retropectoral plane pocket was created in 4 sequential dissection steps with direct endoscopic visualization and careful control of bleeding. Shaped cohesive gel implants were placed to produce smooth, natural-appearing breast mounds and well-defined IMFs.
  
  
  RESULTS
  Patients were monitored for 6 to 24 months after surgery (mean, 10 months; median, 12 months). There were no instances of pneumothorax, instrument-related skin burns, or severe implant deformation due to rotation or displacement of the implants postoperatively. Three of 116 patients (2.6%) experienced Baker 3 unilateral capsular contracture. One patient developed a unilateral hematoma at 3 weeks after surgery.
  
  
  CONCLUSIONS
  Endoscopic breast surgery is associated with shortened recovery times, a reduced need for drainage, and excellent outcomes, including a well-defined and symmetric IMF. This approach, combined with shaped gel implants, can yield natural-appearing results of transaxillary breast augmentation.
  
  
  METHODS
  4 Therapeutic.
authors.affiliation: Drs Sim and Sun are plastic surgeons in private practice in Seoul, Republic of Korea.
authors.forename: Hyung-Bo
authors.initials: HB
authors.lastname: Sim
authors.affiliation: Drs Sim and Sun are plastic surgeons in private practice in Seoul, Republic of Korea.
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Sun
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data; D001365:Axilla / Q000601:surgery*; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D018427:Breast Implants; D015331:Cohort Studies; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D011475:Prosthesis Failure; D018570:Risk Assessment; D020034:Silicone Gels / Q000494:pharmacology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020034:Silicone Gels