The role of endoscopy and implant texture in transaxillary submuscular breast augmentation.

In 1996 the authors reported their experience with 92 consecutive patients undergoing traditional (nonendoscopic) transaxillary submuscular breast augmentation. They reported a capsular contraction rate of 1.1% using textured saline implants, as well as an implant malposition rate of 8.6%. At that time they hypothesized that "the endoscope will lessen the rate of implant malposition." To clarify the role of implant texture and to justify the use of endoscopic techniques in transaxillary submuscular breast augmentation, the authors have studied an additional 58 consecutive patients with two significant changes. First, the endoscope was used to dissect the implant pocket in each patient. Second, smooth-wall implants were substituted for the previously used textured implants. Their rate of implant malposition dropped significantly, from 8.6% to 2.0% (p = 0.10), and their capsular contraction rate remained low, at 2.0% (p = 0.63). They conclude that direct endoscopic control improves implant positioning in the transaxillary submuscular operation, and implant texture does not improve capsular contraction rates when the prosthesis is placed in the submuscular position.