What is transaxillary breast augmentation?

The implant is placed through a short incision hidden in a natural fold of the armpit, so no scar is left on the breast itself. The pocket is dissected at a distance from the entry point, which is why visualisation inside the pocket is the variable under study.

What did the randomized trial actually find?

Two outcomes differed significantly out of everything measured. Grade 1 animation deformity occurred in 20 of 59 patients in the blind arm versus 8 of 59 in the semiendoscopic arm (p = 0.016), and operating time was 46 versus 58 minutes (p = 0.001). Everything else, including capsular contracture, did not reach significance.

Does the endoscope reduce capsular contracture?

This trial does not show that. Baker grade 3 contracture occurred in 4 patients in the blind arm versus 1 in the semiendoscopic arm, but p = 0.170, which is not statistically significant. With 59 patients per arm, a difference of a few cases moves the percentage a long way. It is more accurate not to read more into it than the data support.

Does the longer operating time add risk?

In this trial the semiendoscopic group took about 12 minutes longer, 58 minutes versus 46 minutes (p = 0.001). Hematoma, seroma and infection were recorded as zero in both arms over two years of follow-up.

Can the result be attributed to the technique alone?

Not cleanly. Both arms received botulinum toxin and prophylactic medication as part of the study protocol, so the difference between the arms reflects the technique layered on top of that protocol, not the technique in isolation.

Incision Options

Transaxillary Breast Augmentation: What Changed in 118 Patients With and Without an Endoscope

UNE Plastic Surgery · Dr. Kim Uigeon, board-certified plastic surgeon · Published 2026-10-03 · Updated 2026-10-03

In transaxillary augmentation, grade 1 animation deformity occurred in 20 of 59 patients when the pocket was made without direct vision, and in 8 of 59 when a video-assisted endoscopic technique was used. That is the result of a randomized trial of 118 patients followed for two years.¹ It is also, out of everything the trial measured, one of only two differences that reached statistical significance. This article goes through what the trial found, what it did not find, and where the line between those two sits.

What kind of study is this?

Boliglowa and colleagues randomly assigned 118 women having transaxillary breast augmentation to two groups of 59, and compared them over two years. It was published in Plastic and Reconstructive Surgery in 2026.¹

Participants: 118, at two Polish centres, Kraków and Nowy Targ, April 2019 to December 2022
Allocation: blind technique 59, semiendoscopic video-assisted technique 59, randomly assigned
Surgeon: all operations performed by a single plastic surgery team
Follow-up: 1, 2, 4 and 8 weeks, then 6, 12 and 24 months, with ultrasound examination

Two details decide how the numbers should be read. The technique tested was semiendoscopic, meaning the endoscope was used for part of the pocket work, and it added a 2 to 3 mm accessory incision at the lateral inframammary fold. And both groups received botulinum toxin and prophylactic medication under the study protocol, so what is being compared is two techniques on top of the same protocol.

The one thing the endoscope changed

Animation deformity is the distortion that appears when the pectoralis muscle contracts over an implant sitting under it. Grade 1 is the mild form.

Grade 1 animation deformity: blind 20 of 59, semiendoscopic 8 of 59, p = 0.016
Grade 2 animation deformity: blind 2, semiendoscopic 0 (p = 0.49, not significant)
Operating time: blind 46 minutes, semiendoscopic 58 minutes, p = 0.001

With the blind technique, roughly one patient in three showed the mild form. Why would seeing inside change that? The authors connect it to the dual plane. When a dual plane is created, the lower attachments of the pectoralis are released on purpose, and how far that release runs is what determines how the muscle behaves afterwards.² Released under direct vision, that line is a decision. Released blind, it is an estimate.

The two grade 2 cases in the blind group needed revision. The endoscopic group had none, though with numbers this small that difference did not reach significance.

Did capsular contracture go down?

This is the question that comes up most often about the transaxillary route, and the honest answer is that this trial did not show it.

Capsular contracture, Baker grade 3: blind 4, semiendoscopic 1, p = 0.170
Double bubble deformity: blind 4, semiendoscopic 1, p = 0.170
Bottoming out: blind 2, semiendoscopic 1 (p = 0.56)
Hematoma, seroma, infection: zero in both groups

Four against one reads as a real reduction, but a p value of 0.170 means chance cannot be ruled out. With 59 patients in a group, one or two cases move the percentage a long way. It is more accurate not to read more into it than the paper does.

One caution about the paper itself: its abstract describes the outcomes as significantly improved, which is broader than the results table supports. Two endpoints reached significance, and they were animation deformity and operating time.

The surgical method described in the paper

In the semiendoscopic group, the pocket was completed under video assistance and the muscle release was performed under direct vision. The accessory incision at the lateral inframammary fold, 2 to 3 mm, was what allowed the instruments to reach that plane. Closure was done so that sutures did not need removal, leaving a thin scar. A wired bra was worn for six months after surgery.¹

The paper also cites earlier reports of 75 to 137 minutes for fully endoscopic approaches, and argues that a semiendoscopic technique is favourable on time. Those figures come from other centres and other techniques, so they are context rather than a comparison; operating times do not transfer between surgeons.

At UNE Plastic Surgery the whole procedure is performed endoscopically through the armpit, from the incision to closure, and a first-time augmentation is typically completed in 27 to 40 minutes. That is a description of how we operate, not a finding of this trial. The trial tested a semiendoscopic technique with an accessory incision, and it does not validate a fully endoscopic approach.

What shows at revision

The worry about entering through the armpit is usually not the first operation but the second. The paper includes one case: a 36-year-old in the blind group developed a right-sided capsular contracture at one year and underwent revision, and at two years the authors record that the axillary scar was barely visible.¹

One case is an illustration rather than a rate, and the published figure legend does not state explicitly that the original incision was reused. What it does support is narrower and still useful: an axillary scar that has matured for two years can be inconspicuous, including in someone who has had a second operation.

Three points to take away

One clinical outcome changed. Grade 1 animation deformity, 20 of 59 versus 8 of 59, p = 0.016. That was the only complication endpoint to reach significance; operating time was the other significant difference, at 46 versus 58 minutes.
Capsular contracture was not shown to fall. Four versus one, but p = 0.170. Double bubble was the same picture. Hematoma, seroma and infection were zero in both groups.
The limits are real. 118 patients, two years of follow-up, one surgical team, and both groups on the same adjunct protocol. Capsular contracture can appear years later, so two years cannot settle it.

References

Boliglowa D, Pontillo M, Velotti N, Rocco N. Transaxillary breast augmentation: comparing a new semiendoscopic video-assisted technique versus the blind technique. Plast Reconstr Surg. 2026;158(1):43e–52e. doi:10.1097/PRS.0000000000012546. PMID: 41115293.
Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg. 2006;118(7 Suppl):81S–98S. doi:10.1097/01.prs.0000234610.30556.84.