Endoscopic Breast Augmentation: What We Learned From 1,389 Patients
By Dr. Shim Ching, MD, FACS | Board-Certified Plastic Surgeon
If you're considering breast augmentation, you probably have a few important questions: How safe is the procedure? Will I have visible scars? What happens if my implants need to be replaced or corrected in the future?
These are questions I regularly discuss with my patients. Fortunately, we have published clinical research that helps provide some answers.
Between 2006 and 2021, I performed 1,389 endoscopic transaxillary breast augmentations, a technique that places breast implants through a small incision in the armpit rather than directly on the breast. The results were published in Aesthetic Surgery Journal Open Forum in 2024.
Here's what the research tells us about the procedure, its risks, and what these findings could mean for you.
What Makes Endoscopic Breast Augmentation Different?
Traditional breast augmentation commonly uses an incision beneath the breast or around the areola. With endoscopic transaxillary breast augmentation, the incision is placed within the natural crease of the armpit.
During surgery, I use a specialized camera called an endoscope to see inside the breast pocket while positioning the implant. This allows me to work through an incision away from the breast while maintaining a clear view of the surgical area.
For patients, the potential benefits include:
- No incision directly on the breast: The surgical scar is located in the armpit.
- Camera-guided precision: The endoscope allows me to visualize the implant pocket during surgery.
- Future revision options: Certain implant complications can be corrected through the original armpit incision.
What Did the Study of 1,389 Patients Find?
My published study examined complications following endoscopic breast augmentation, including implant movement, capsular contracture, and bleeding.
Here are the key findings:
|
Clinical finding |
Study result |
What it means for you |
|
Patients studied |
1,389 |
A large group of patients treated using a consistent technique |
|
Overall complication rate |
6.69% |
Documents the complications observed during the study |
|
Implant malposition |
3.64% |
Implants shifting or settling outside their intended position |
|
Capsular contracture |
1.74% |
Scar tissue tightening around an implant |
These results are encouraging, but it's important to understand that every patient's anatomy and surgical needs are different. Complication rates also depend on how long patients are followed after surgery.
What Were the Most Common Complications?
Implant Malposition: 3.64%
Implant malposition occurs when an implant shifts from its intended position, potentially causing one breast to appear higher, lower, or differently shaped than the other.
One interesting finding from our research was that implants placed in the subfascial plane had a lower rate of malposition than implants placed beneath the muscle.
However, the subfascial group also experienced a higher rate of hematoma, or postoperative bleeding. This highlights why choosing the right implant position requires balancing several factors rather than focusing on a single complication.
Capsular Contracture: 1.74%
After breast augmentation, the body naturally forms a thin layer of scar tissue around each implant. Sometimes this tissue tightens, making the breast feel firm or appear distorted. This is called capsular contracture.
Our study recorded a capsular contracture rate of 1.74%.
Although this is an encouraging finding, capsular contracture can develop years after surgery. The study's minimum follow-up was three months, so this figure should not be considered a lifetime risk.
For additional information about breast implant complications, theFDA provides a detailed overview of breast implant risks.
Can Breast Implant Revision Be Performed Without New Breast Scars?
This is one of the most important considerations for patients who want to avoid incisions directly on their breasts.
Breast implants are not lifetime devices. Over time, some patients may want to change their implant size, correct implant positioning, or address a complication.
Perhaps the most relevant finding in our study 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 and 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.
Depending on the circumstances, this may include:
- Replacing implants with a different size.
- Correcting certain types of implant malposition.
- Treating selected cases of capsular contracture.
- Adjusting the existing implant pocket.
Again, not every revision can be performed this way. More complex corrections may require a different surgical approach.
Learn more about endoscopic breast implant revision through the armpit.
Is Endoscopic Breast Augmentation Safer Than Traditional Breast Augmentation?
Our research demonstrates that endoscopic transaxillary breast augmentation can be performed with documented complication rates in a large patient population.
Both approaches have advantages, and the safest option for an individual patient depends on anatomy, implant selection, medical history, and surgeon experience.
Additional research has compared endoscopic transaxillary and inframammary approaches, examining differences in surgical trauma and recovery.
Read the comparative clinical study published in Aesthetic Plastic Surgery.
Frequently Asked Questions Answered
Does endoscopic breast augmentation leave scars?
Yes, but the incision is located within the armpit rather than directly on the breast. The visibility of the scar depends on individual healing.
Can breast implants be placed above or below the muscle through the armpit?
Yes. Endoscopic transaxillary augmentation can be performed using different implant placement planes. The best option depends on your anatomy and aesthetic goals.
Can I replace my breast implants through the same armpit incision?
In many cases, selected implant exchanges and revisions can be performed through the original armpit incision. A consultation is necessary to determine whether this approach is appropriate.
How experienced are you with endoscopic breast augmentation?
I published research documents with 1,389 endoscopic transaxillary breast augmentation patients treated between 2006 and 2021, and have continued performing endoscopic breast procedures since the study period concluded.
Traditional vs. Endoscopic Breast Augmentation: What's the Difference?
While both techniques aim to achieve natural-looking breast augmentation results, the primary difference is how the surgeon visualizes and creates the implant pocket. Endoscopic breast augmentation uses a specialized camera to guide the procedure, while traditional approaches rely on direct visualization or, in some cases, dissection by feel.
|
Feature |
Traditional Breast Augmentation |
Endoscopic Breast Augmentation |
|
Surgical visualization |
Direct view through the incision; limited visibility with non-endoscopic armpit approaches |
High-definition camera provides an internal view of the surgical pocket |
|
Incision location |
Typically beneath the breast, around the areola, or in the armpit |
Typically within the natural armpit crease |
|
Implant pocket creation |
Guided by direct vision and surgical instruments; some approaches rely more on tactile feedback |
Camera-guided dissection allows visualization of pocket boundaries |
|
Bleeding control |
Blood vessels are managed through direct visualization or surgical technique |
Camera helps identify and cauterize blood vessels during dissection |
|
Muscle release |
Performed through the surgical incision, with visibility depending on the approach |
Camera allows visualization of muscle attachments during controlled release |
|
Implant positioning |
Determined by pocket preparation, anatomy, and surgical technique |
Camera assists with pocket preparation and positioning |
|
Visible breast scars |
Depends on incision location; inframammary and periareolar approaches leave scars on the breast |
Avoids incisions directly on the breast; scar is located in the armpit |
|
Future implant revision |
May require an incision beneath the breast or another access point |
Selected revisions may be performed through the original armpit incision |
|
Surgeon training |
Established techniques commonly taught during plastic surgery training |
Requires additional endoscopic skills, experience, and specialized equipment |
Key takeaway: The main advantage of endoscopic transaxillary breast augmentation is the ability to combine an armpit incision with camera-guided visualization. This also allows for certain future implant revisions to be performed through the same incision and avoids additional scars directly on the breast.
Why Don’t All Surgeons Use Endoscopic Breast Augmentation if it Has Some Advantages for Breast Augmentation?
Despite its potential advantages, endoscopic breast augmentation is not widely performed because it requires specialized equipment, additional training, and advanced surgical skills.
Unlike traditional techniques, surgeons must operate using a camera-guided view, requiring precise hand-eye coordination and experience. Because dedicated endoscopic breast surgery training is not standard in most plastic surgery residency programs, surgeons typically need additional training and hands-on experience.
The investment in equipment and the learning curve discourage many of them from adopting the technique. As a result, relatively few plastic surgeons offer endoscopic breast augmentation, and even fewer have the experience necessary to perform complex endoscopic breast implant revisions.
What Does This Research Mean for You?
If you're considering breast augmentation, it's important to look beyond before-and-after photos and understand the surgeon's experience, complication rates, and approach to future revisions.
My published research provides clinical evidence from 1,389 patients, helping you make a more informed decision about whether endoscopic transaxillary breast augmentation is right for you.
For women interested in avoiding incisions directly on the breast, this technique may offer an appealing option. And for patients who already have implants, endoscopic revision may provide a way to address certain concerns without creating additional breast scars.
To explore your options, learn more about breast augmentation with Dr. Shim Ching or endoscopic breast implant revision.
Research and Medical References
- Sardiwalla Y, Ching S. Endoscopic Transaxillary Breast Augmentation: A Case Series of 1300 Patients. Aesthetic Surgery Journal Open Forum. 2024. View research.
- Surgical Trauma Comparison of Inframammary Fold versus Endoscopic Transaxillary Approaches in Breast Augmentation: A 7-Year Cohort Study. Aesthetic Plastic Surgery. View research.
- U.S. Food and Drug Administration. Risks and Complications of Breast Implants. View FDA guidance.