Why don’t more PS use the transaxillary breast augmentation using endoscopy technique?

The transaxillary approach involves making an incision in the armpit. The pocket for the implant can be dissected blindly and bluntly with special instruments. It can also be dissected with an endoscope and electrocautery under direct vision. The endoscope allows visualization of bleeding vessels that can be directly controlled. Reported disadvantages include poor pocket visualization and control, which is largely dependent upon surgeon comfort with the procedure and the number of procedures performed through this approach. The scar in the hairbearing area of the axilla may cause shaving difficulties. If removal of the implant is necessary in the future due to implant rupture or capsular contracture, an incision on the breast mound, either periareolar or inframammary, may be necessary.

I think a lot of surgeons are against transaxillary breast augmentation because they do not feel comfortable performing it or they even never tried or got train in performing it. I learned how to safely and successfully perform this type of breast augmentation over 25 years ago. Since then I augmented many thousands of breasts this way and this is my experience: it is my preferred way to do it (for a right candidate) my main reason is: why mutilate perfect beautiful woman's body if you can avoid it? And there is really no downside, it is not true that are more complications, problems or capsular contractures than with any other way to do it. If surgeon is skilled and knows how to perform axillary breast augmentation results are very predictable. I would not be repeating this procedure for over 25 years if it would be causing problems. It would be insane since I sometimes have 10 patients /week and would ha to deal with a lot of unhappy women... And do not trust surgeons who tell you under the breast incision is great. Frequently, they are quite visible, stretched, dark, keloidal and quite annoying. Especially in small breasts that have no folds make these scars impossible to hide. Last time I performed inframammary incision is over 20 years ago. There is no need for that. Armpit incisions ALWAYS heal great, and they are either invisible or look like a wrinkle in your armpit. And in my experience problems that people are describing are if anything less common that with other approaches.

This incision does carry the highest risks, including the highest risks of capsule formation. The axillary skin is not as clean of an area as the breast skin. Also, it can be a difficult incision to reuse, and may not work well with all implants. When you are sleeveless and raise your arm, the incision may be noticeable. More women go sleeveless than bare chested. For these reasons, I choose not to use this incision.