The American Journal of Cosmetic Surgery Vol. 15, No.4, 1998 Transaxillary Endoscopic Augmentation: An Analysis of 100 Cases WILLIAM YVORCHUK, M.D.* 335 Over the last three decades, there has been a large de- mand for elective breast enhancement. Endoscopic technol- ogy has expanded the techniques available for breast aug- mentation. There is a relative paucity of information on the outcomes of these endoscopic techniques. This series is pre- sented to report on a series of approximately 100 consecu- tive patients who have undergone transaxillary endoscopic augmentation mammoplasty, primarily with smooth implants placed in the subpectoral position. This technique has re- vealed itself to be a safe, reliable, and versatile approach to breast augmentation that has allowed for a high degree of control in the performance of the procedure. The com- plication rate is relatively low and highly favorable com- pared with that of other methods of augmentation. The re- quirement for revisional surgery is minimal, and such sur- gery can be performed through the original approach and, to date, has been performed without the requirement for a counterincision. This technique can readily be taught with a high degree of predictability in planning and execution. A ugmentation mammoplasty has proven to be of benefit to patients suffering from hypomastia. These patients report marked changes in their per- ceived body image that clearly translate into improve- ment in self-esteem and self-confidence.':" There ap- pears to have been a resurgence in the demand for elective breast enhancement over the last few years after some settling of the media frenzy accompanying the withdrawal of silicone gel implants by the Food and Drug Administration. The average plastic surgery patient is far more ed- ucated about aesthetic procedures than in the past, and many enter the office sometimes requesting, and oc- casionally demanding, procedures that incorporate re- cent advances in technology. An example of this me- dia-driven focus on technology is the application of endoscopy to augmentation mammoplasty. The trans- axillary approach has already been established as a safe and viable alternative for breast enhancement sur- gery.6--14 The transaxillary and umbilical approaches Received for publication March 19, 1998. * Institute for Aesthetic and Reconstructive Surgery, Upland, California. are currently the two most frequently practiced appli- cations of the endoscope for breast enhancement sur- gery. The use of the endoscope has transformed the traditional transaxillary procedure and has made it far more popular than in the past. This review will focus on the refinements and results in a series of approximately 100 consecutive cases of augmentation mammoplasty performed through the trans axillary approach coupled with endoscopic visu- alization. This technique has revealed itself to be a safe, reliable, and versatile approach to breast aug- mentation that has allowed for a high degree of control in the performance of the procedure. Once a certain affinity with the use of the endoscope has been ac- quired, there is a relatively shallow learning curve, and very satisfactory surgical results can be obtained in reproducible fashion and with a high margin of safety. In our practice, the transaxillary approach has be- come the favorite of the patient population that does not require a concomitant mastopexy procedure. The scars are confined to a favorable region that does not lend itself to scar hypertrophy, and the physician avoids the placement of scars on the breast mound. The complication rate is relatively low and highly fa- vorable compared with that of other methods of aug- mentation.P'<' The requirement for revisional surgery is minimal, and such surgery can be performed through the original approach and, to date, has been performed without the requirement for a counterinci- sion. This technique can readily be taught with a high degree of predictability in planning and execution. The procedure does not have a particularly steep learning curve for surgeons already familiar with endoscopic techniques but does require some augmentation mam- moplasty experience. The following series of approximately 100 consec- utive cases is presented with an analysis of the results. The complication rate is highly favorable, with a min- imum of reoperations. Of significance is the fact that counterincisions were never required, either for the ini- tial procedure or for revisional procedures to date. It is advised, however, that early in the surgeon's expe- rience with this technique, the patient should be in- formed that a counterincision may be required, either during the procedure for better access or at a later date in the case of a revisional procedure.