Transaxillary subpectoral augmentation mammaplasty: a single surgeon's 20-year experience

Transaxillary subpectoral augmentation mammaplasty (TASPA) is not widely accepted due to perceived limitations in pocket access, visualization, control, and subsequent risk for postoperative complications. Current published data do little to substantiate or refute those claims.

A retrospective chart review of a single surgeon's 20-year experience with the TASPA technique was undertaken to assess the incidence of total secondary procedures, implant-related revisions, and reoperations unrelated to the implant.

The senior author (DCM) performed 1776 primary TASPA procedures from January 1989 through December 2008. Of those, 94 patients did not meet inclusion criteria, leaving a total of 1682 records for analysis. Data reviewed included age, date of surgery, race, implant size and type, manufacturer, and reasons for reoperation.

Average age was 32.7 ± 8.1 years (range, 16-62). Average implant size was 438.5 ± 51.5 cc (range, 270-630). Implants from Allergan/Inamed/McGhan (Irvine, CA), Dow-Corning (Midland, MI), Mentor (Santa Barbara, CA), and Surgitek (Racine, PA) were inserted (n = 2094 saline, n = 1270 silicone). Mean follow-up time was 37.9 ± 45.4 months (range, one month to 19.8 years). Excluding staged mastopexies and treatment for breast cancer, total secondary procedures were required in 225 patients (13.4%). Implant-related revisions included malposition (2.97%), size change (2.5%), and capsular contracture (1.9%). Perioperatively, no infections occurred, and two patients (0.12%) experienced hematoma. Most reoperations (62.8%) were performed through the axilla. Comparison to published data showed an equal or lower rate of capsular contracture, hematoma, and infection with the TASPA approach.

Given its advantages of an inconspicuous scar, decreased infection, and decreased capsular contracture, TASPA can be safely offered to patients as an option in breast augmentation.