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Transaxillary Totally Subfascial Breast Augmentation with Anatomical Breast Implants: Review of 27 Cases

Aygit, Ahmet C. M.D.; Basaran, Karaca M.D.; Mercan, Ebru Sen M.D.

Plastic and Reconstructive Surgery: May 2013 - Volume 131 - Issue 5 - p 1149–1156
doi: 10.1097/PRS.0b013e3182865d68
Cosmetic: Original Articles

Background: The transaxillary route is a popular method of breast augmentation because it is associated with inconspicuous scars. The subfascial plane carries the advantages and decreases the disadvantages of subglandular and submuscular planes. In the technique described, the authors placed the implant totally subfascially to strengthen the advantages of the traditional subfascial plane.

Methods: Twenty-seven patients (50 breasts) were included in the study from 2009 to 2012. The mean patient age was 27.3 years (range, 19 to 32 years). An axillary incision was performed and the pectoralis major fascia was opened initially. With endoscopic assistance, the dissection continued craniocaudally underneath the fasciae of the pectoralis, serratus, and rectus abdominis muscles. Patients were followed up in terms of rippling, implant visibility, capsular contracture, and asymmetry.

Results: Patients were followed up for an average of 21 months (range, 7 to 28 months). Anatomical, textured, and cohesive gel implants were used, with a mean implant size of 235 cc (range, 180 to 300 cc). In terms of the Baker classification, only 16 percent of the patients had grade II capsular contractures. There were no cases of malpositions, wrinkling, or rippling. Overall satisfaction was quite high (96 percent), and none of the patients required an implant removal or change.

Conclusions: A modification of the subfascial plane was demonstrated where the implants have been placed totally subfascially, in contrast to the traditional subfacial techniques. Satisfactory results have been obtained in terms of breast shape, nipple sensitivity, capsular contracture, and implant visibility. However, more long-term results are needed to evaluate the exact effect of total fascial coverage.


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Bagcilar, Istanbul, Turkey

From Bagcilar Research and Training Hospital.

Received for publication September 2, 2012; accepted November 20, 2012.

Disclosure: None of the authors has a financial interest in any of the products or devices mentioned in this article.

Supplemental digital content is available for this article. A direct URL citation appears in the text; simply type the URL address into any Web browser to access this content. A clickable link to the material is provided in the HTML text of this article on the Journal’s Web site (

Plastik, Rekonstruktif ve Estetik Cerrahi Klinigi, Bagcilar Research and Training Hospital, Merkez Mah., 1. Kat, Bagcilar, Istanbul, Turkey,

©2013American Society of Plastic Surgeons