Augmentation mammaplasty with anatomic soft, cohesive silicone implant using the transaxillary approach at a subfascial level with endoscopic assistance

Many augmentation mammaplasty techniques have been developed paying special attention to incision location and pocket plane to achieve more natural-looking breasts. The authors' technique of choice in patients with mammary hypoplasia, empty breasts following a diet program, or more than one lactation episode causing skin flaccidity without ptosis is the placement of an anatomical implant using a transaxillary approach in a subfascial plane with endoscopic assistance. Thus, ideal patients are those presenting mammary hypoplasia, empty breasts following two or more lactation episodes, and breast skin flaccidity without ptosis, with the nipple-areola complex placed above the inframammary fold. The technique and its indications are presented thoroughly. Forty-five patients were operated on using this technique from May of 2001 to October of 2003. One-year follow-up results showed highly rated patient satisfaction. One patient underwent an implant exchange because of implant size dissatisfaction. The authors prefer subfascial plane implants to submuscular ones. Possible rotation of anatomic implants and the subsequent asymmetry when contracting the pectoral muscle are avoided. Pectoral muscle is not detached from its insertions, resulting in less postoperative pain. Likewise, the authors prefer a subfascial to subglandular pocket since the weight of the subglandular pocket and the glandular weight itself are borne by the skin envelope leading to breast ptosis development over time. On the other hand, fascia provides additional support to the subfascial implant, thus eliminating ptosis development and achieving good filling of the upper pole similar to the filling provided by subglandular implants.