This article presents an overview of the transaxillary subfascial approach to primary breast augmentation with the latest-generation anatomic form-stable silicone implants. Although the axillary approach is a well-described technique for breast augmentation, there have been few reports concerning the subfascial pocket, especially in association with anatomic form-stable texturized silicone gel implants. The authors present their experience with the present technique, along with technical details concerning the placement of the superior pole of the anatomic implant underneath the superficial fascia of the pectoralis major.
The transaxillary approach to breast augmentation is a successful technique that not only provides an inconspicuous incision but also offers the advantages of adequate placement of the inframammary crease and subfascial dissection under direct visualization.
In the upper breast pole, the pectoral fascia helps to decrease visualization of the edges of the implant and provides soft-tissue coverage over the anatomic implant. The technique avoids the negative aspects of the submuscular position and provides a more comfortable recovery than the total submuscular pocket.
An important characteristic of anatomic cohesive gel implants is their form-stable nature and their ability to maintain shape in all positions without significant deformation. This form-stable characteristic results from a higher degree of cross-linking within the gel.
Ideal primary candidates are those who have significant hypomastia/amastia, are thin without sufficient soft tissue to adequately cover the implant, and have an absent or high inframammary fold. Patients who require greater volume in the lower breast and want to avoid visible incision scars on their chests also benefit from the present technique.