A Preliminary Report on the Transthelial Approach to Breast Implant Exchange

Augmentation mammoplasty is a popular aesthetic surgical procedure with over 300,000 cases performed in the United States annually, making it the second most common aesthetic surgical procedure after liposuction. Although traditional approaches to implant exchange can result in noticeable scarring, the transthelial approach offers scar concealment and direct implant access which may be advantageous for scar-averse patients. This article describes a single surgeon's preliminary experience with the transthelial approach to breast implant exchange. A retrospective chart review was performed from a single board-certified plastic surgeon to identify patients who had undergone implant exchange with a transthelial approach. Six patients were identified who underwent breast implant exchange through the transthelial approach between 2017 and 2020. All patients previously underwent saline-based implant placement through a transumbilical approach. The cohort's median age was 32 (27-50), with a median BMI of 20.4 (19.4-22.3). All patients reported satisfaction with their scars, maintenance of nipple-areolar complex sensation, and preserved vascularity. One patient (14%) had recurrence of Baker Grade IV capsular contracture which improved with nonoperative management. There were no reports of implant failure, hematoma, seroma, infection, malposition, delayed wound healing, or reoperations in this cohort. The transthelial approach is a viable option for breast implant exchange in select patients. It has the advantage of scar concealment in a naturally striated and irregular tissue, preferable for scar concealment. To obtain more conclusive and generalizable data, larger studies with longer follow-up periods are encouraged. Level of Evidence: 4 (Therapeutic).