Background:  Transaxillary subpectoral augmentation mammoplasty (TASPA) has become an important option in the plastic surgeon’s repertoire due to its preserved integrity of the aesthetic unit of the breast and easy access to the tissue planes.   Concerns over visualization of the pocket during blunt dissection have led to apprehension in obtaining adequate hemostasis and accuracy of the pocket dissection, which could lead to higher complication or surgical revision rates.  This study evaluates the outcome of 20 years of experience with the senior author’s described technique utilizing blunt dissection and looks at the senior author’s secondary surgical procedure rate, defined and subcategorized as revision and reoperation rates.

Methods:  A retrospective review of the surgical patterns in 1890 patients who underwent  TASPA between January 1989 through December 2008 was performed using database query and medical chart review.  Secondary surgical procedures are identified as revisions (surgeries to address hematoma, capsular contracture, size change, implant rupture or crease asymmetries) or reoperations (mastopexy, elective removal of implants or replacement of saline implants for silicone).  The senior author’s technique is described in detail.

Results:  One thousand eight hundred and ninety patients qualified for this study.  Average patient age was 33.9 years.  The average implant volume was 427cc.  Slightly more than 9% of patients required a secondary surgical procedure over the course of the study.  The secondary surgical rate at 20 years is 9.2%, regardless of implant type.

Conditions leading to revisional surgery include:  3 hematomas (0.2%), 18 ruptures (1.1%) with rupture rate increasing exponentially with increasing age of implant, 18 capsular contractures requiring capsulectomy (1.1%) without a difference in capsular contracture rate between saline and silicone implants and 41 malpositioned implants leading to pocket revisions (2.4%).  Perioperative infection (0%) did not contribute to revisional  surgery.

Conclusions:  TASPA using the reported method has a lower secondary surgical procedure incidence when compared to the 5-year FDA statistics, as well as a lower hematoma, infection, and capsular contracture rate when compared to the nationally published average.