Balloon-Assisted Transaxillary Augmentation Mammoplasty: A Simplified 3-Step Approach

Abstract

Introduction: Transaxillary augmentation mammoplasty has been an approach used by plastic surgeons for more than 2 decades. Considered controversial because of the potential for incomplete dissection, implant malposition, and traumatic pneumothorax secondary to blind dissection, the current trends for transaxillary augmentation mammoplasty include use of an endoscope for the entire dissection. This review of the literature presents an alternative approach to the traditional endoscopic transaxillary augmentation mammoplasty. The balloon-assisted transaxillary augmentation mammoplasty (BAAM) uses a specific 3-step sequence, enabling adequate pocket dissection with minimal risk of trauma in an efficient and timely manner. Materials and Methods: In this series BAAM was performed on 56 patients over 18 months. Patients were selected according to 5 specific criteria, including desired location of the scar, degree of ptosis, desired implant size, and minimal breast asymmetry. Using these specified criteria allowed a technique to be developed that was consistent and easily reproducible from patient to patient. Results: Of the 56 patients that were included in the study, minimal complications were noted. At 18 months, 1 person (1.8%) developed a capsular contracture grade III. There were no appreciated hematoma formations or infections of the prosthesis. In addition, 1 patient (1.8%) developed an incisional infection of the right axilla, which resolved with oral antibiotics. Seven patients (12.5%) presented with high-riding implants, 6 of which resolved over a course of 3 to 6 months with superior breast implant massage. One patient (1.8%) was taken back to the operating room where a counterincision at the inframammary crease was used to create a new inframammary fold, thus lowering the implant. During the course of the study, no ruptures were appreciated. Finally, of the 56 patients, 7 (12.5%) experienced parasthesias of the nipple, all of which resolved over a 3-month interval. Conclusion: Balloon-assisted transaxillary augmentation mammoplasty is the current method of choice for breast enhancement. In the 3-step sequence presented, the focus is on a simplified approach to achieve complete submuscular implant placement in an efficient and timely manor.