Between 2006 and 2021, I performed endoscopic transaxillary breast augmentation on over 1,300 patients using a consistent technique: a 30-degree endoscope, electrocautery dissection under direct vision, smooth round silicone gel implants ranging from 180 to 800cc, placed in either the subfascial or submuscular plane. The results of this series were published in Aesthetic Surgery Journal: Open Forum in 2026.
What follows is a patient-accessible summary of what this data shows and what it means for women considering endoscopic breast augmentation or revision.
Overall Complication Rate
The overall complication rate in the series was 6.69%. To put this in context, published complication rates for breast augmentation across all incision approaches and techniques typically range from 5% to 15%, depending on the definition of complications, the length of follow-up, and the patient population. Our rate falls at the lower end of this range.
This is significant because one of the persistent criticisms of the transaxillary approach is that it carries higher complication rates than inframammary or periareolar techniques. Our data does not support this claim.
Malposition
Implant malposition was the most common complication at 3.64%. This includes all forms of malposition — implants riding too high, bottoming out, lateral displacement, or asymmetric positioning.
An important finding: we observed a statistically significant decrease in malposition in the subfascial group compared to the submuscular group. This suggests that the plane of placement has a meaningful impact on malposition risk, independent of the incision approach. The subfascial plane provides a more defined pocket boundary that resists implant migration.
For patients, the practical takeaway is that malposition risk in endoscopic transaxillary augmentation is comparable to published rates for other approaches, and plane selection can further reduce this risk.
Capsular Contracture
The capsular contracture rate in our series was 1.74%. Published contracture rates across the literature vary widely — from under 2% to over 10% — depending on the implant type, surface texture, placement plane, and follow-up duration. Our rate at 1.74% compares favorably with the best published outcomes.
One factor that may contribute to this low contracture rate is the transaxillary approach itself. Because the incision is remote from the breast, the implant does not contact breast glandular tissue during insertion. The Keller Funnel no-touch technique further reduces the risk of bacterial contamination of the implant surface, which is increasingly recognized as a contributing factor in capsular contracture development.
Hematoma
We observed a significant increase in hematoma rate in the subfascial placement group compared to submuscular. This is an important finding that informs surgical planning. Subfascial placement, while offering advantages in malposition rates, requires more meticulous hemostasis. The endoscope’s ability to identify and cauterize blood vessels under direct visualization is particularly valuable in this context.
What the Data Means for Revision
Perhaps the most relevant finding for women considering revision is that complications in this series were largely managed using endoscopic techniques. This means that when a patient in this cohort developed malposition or contracture, the correction was performed endoscopically through the same armpit incision — not through a new breast incision.
This is the clinical foundation for what I offer revision patients: a technique with documented long-term outcomes where the primary approach and the revision approach use the same minimally invasive access.
Limitations of the Data
Intellectual honesty requires acknowledging limitations. This is a Level V evidence study — a single-surgeon case series without a randomized control group. It demonstrates safety and efficacy across a large cohort, but it does not prove superiority over other approaches in the way a randomized controlled trial would.
The minimum follow-up period was three months post-procedure. Longer-term follow-up captures additional complications that may not manifest in the early postoperative period. Published literature on breast augmentation suggests that some complications, particularly capsular contracture, continue to accumulate over years.
These limitations are standard for large surgical case series and do not diminish the utility of the data. They simply define the appropriate level of confidence in interpreting results.
What This Means for You
If you are researching endoscopic transaxillary breast augmentation, this published data gives you something concrete to evaluate. It represents a large cohort with documented complication rates that compare favorably with published norms across all incision approaches.
If you already have implants and are considering revision, the relevant insight is that the surgeon performing your revision should have documented experience managing complications with the same technique used for the primary augmentation. A revision specialist working within an established system of endoscopic technique, with published outcomes data, is a different proposition than a surgeon attempting endoscopic revision without that foundation.