Reoperative Transaxillary Breast Surgery: Using the Axillary Incision to Treat Augmentation-related Complications

The axillary incision for breast augmentation has been an option for patients and surgeons for more than 30 years now. Controlled clinical trials have demonstrated that reoperations continue to be significant (15-24% at 3 years) independent of incision choice. The misbelief that the transaxillary approach is not adequate for reoperations inhibits patients' and surgeons' decisions on what incision is best in each case. A retrospective analyses was performed seeking reoperation cases performed from January 2008 to January 2011 that used the same axillary incision as the previous transaxillary augmentation. Data on the cause for the reoperation, time between surgeries, patient age, implant volume, locality of the primary operation, and details regarding the implant type and pocket plane were gathered and analyzed. A total of 15 patients and 26 breasts needing reoperation were found in this period. The average time between the first surgery and reoperation was 12 months, average patient age was 36 years, and implant volume ranged from 195 to 360 cc, with an average of 283 cc. Six of these patients were previously operated on by the authors and nine were operated on by other surgeons and came to our service seeking revision. Details regarding the implant type and pocket plane are also given. The main causes for reoperation were capsular contracture (26.9%), size change (15.4%), seroma/hematoma (11.5%), infection (11.5%), axillary banding/scarring (11.5%), lower-pole deformity/high-riding (11.5%), asymmetry (7.7%), and rippling/waviness (3.8%). Transaxillary breast augmentation reoperation is feasible if certain principles are followed.