Incidence of intercostobrachial nerve injury after transaxillary breast augmentation

Background: Although many studies on transaxillary breast augmentation (TBA) have been published, none has examined the incidence of intercostobrachial nerve (ICBN) injury after aesthetic surgery. Objective: This study was designed to measure the incidence of ICBN injury after endoscopic and non-endoscopic TBA, and to determine anatomic guidelines for the avoidance of iatrogenic injury to the ICBN. Methods: A questionnaire was distributed nationally to 1000 plastic surgeons selected randomly from the roster of the American Society of Plastic Surgeons. The questionnaire sought information on the surgeons' experience, technique, and complication rate with regard to TBA. Anatomic dissections of 6 unpreserved axillae were also performed. Results: Our survey response rate was 50%; of those responding, 26.8% of surgeons (134) performed TBA. Of the 134 surgeons performing TBA, 72 (53.7%) used an endoscope. The overall complication rate was 62.7%, which included upper-arm and shoulder pain, numbness, sensory loss, and tingling, and upper-arm fibrous banding. No significant differences were seen between the complication rates for the endoscopic (66.7%) and open (58.1%) TBA groups. With few exceptions, all symptoms resolved in 3 to 6 months. The dissection study confirmed the location of the ICBN as being immediately subcutaneous in the axilla. Conclusions: TBA is associated with a high incidence of injury to the ICBN. Our findings indicate that the use of an endoscope with the transaxillary approach does not significantly affect the rate of injury to the ICBN. The dissection study performed helped to confirm that an immediately subcutaneous plane of dissection in the axilla is safest with regard to avoiding injury to the ICBN. ( Aesthetic Surg J 2002;22:26-32.)