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Comparing Transaxillary Endoscopic Assisted Technique with the Inframammary Approach for Augmentation Mammaplasty: 16-Year Experience
Ali Izadpanah, MD,CM, Hani Sinno, M.D, C.M., M.Eng., Arash Izadpanah, B.Sc., William Papanastasiou, MD, MSc, FRCSC.
McGill University, Montreal, QC, Canada.

Purpose
Since its introduction, augmentation mammaplasty has gained widespread popularity. During the last decade transaxillary endoscopic breast augmentation (TAEBA), often referred to as “scarless” approach, has gained extreme popularity. Thus, we sought to compare the inframammary with TAEBA for safety, rates of postoperative complications and patient’s satisfaction.
Methods
A retrospective chart review of 680 patients undergoing 1386 implant insertion for breast augmentation using inframammary or TAEBA was performed. All patients underwent augmentation mammaplasty surgery for cosmetic reasons. Odds ratio and Pearson Chi Square data analysis was used.
Results
680 patients underwent aesthetic augmentation mammoplasty with a mean age of 33.4 ± 9.54 years, out of which 365 patients opted for inframammary approach (mean age of 34.2 ± 6.82 years) and the remainder chose to undergo the TAEBA. The mean follow up time was 12.1 ± 6.9 months.
Inframammary breast augmentation had higher odds of having postoperative capsular contracture (OR=1.41; p=0.023), seroma (OR=3.83; p=0.001), wound dehiscence (OR=2.61; p<0.001) and prominent scar formation (OR=3.32; p<0.001) compared to the TAEBA. On the other hand, patients undergoing TAEBA demonstrated higher hematoma formation (OR=1.96, p=0.036) and inframammary fold irregularities (OR=5.88; p=0.001). Patients had similar satisfaction rates and both techniques demonstrated similarly low complications rate.
Conclusions
Both the inframammary and transaxillary incisions are relatively safe procedures with high patient satisfaction. The transaxillary incision can be an alternative option for many patients with lower odds of having prominent postoperative scarring, seroma formation, capsular contracture and wound dehiscence.
Overal Complication Rate
ComplicationTrans-Axillary n (%)
Total 630 implants
Infra-Mammary n (%)
Total 730 implants
Hypertrophic Scar8 (1.3%)29 (1.2%)
Wound Dehiscence1 (0.2%)3 (0.12%)
Seroma3 (0.5%)13 (1.8%)
Infection7 (1.1%)5 (0.7%)
Capsular contracture22 (3.5%)35 (4.8%)
Hematoma10 (1.6%)8 (0.82%)
IM FOld Irregularities10 (1.6%)2 (0.28%)
NAC Sensory Changes7 (1.1%)13 (1.8%)
Lymphedema0 (0%)0 (0%)


Incision Type and Perioperative Complications
Type of Incision
(Inframammary vs. Transaxillary)
Odds Ratiop Value
Capsular Contracture1.410.023
Hematoma0.510.036
Seroma3.830.001
Infection0.610.256
Dehiscence2.610.000
IM Fold Irregularities0.170.001
NAC Sensory Changes1.630.109
Malposition1.390.246
Prominent Scar3.320.000


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