Introduction: The number of transaxillary approaches has increased on breast augmentations and most surgeons place a linear or curved incision, creating a tunnel towards the pectoralis muscle margin. The objective of this study is to describe the axillary incision in a Z form in order to facilitate its approach with a direct access to the muscle margin, no subcutaneous tunnel needed and good aesthetic results in a scar with tension line breaking.

Methods: 344 patients were operated aging from 18 to 50 years old between 2004 and 2009. Patients desiring breast augmentation and breasts free of scars were selected. Exclusion criteria: previous breast surgery, ptosis, asymmetry, tubular breast. The non endoscopic axillary approach was used with submuscular plane and textured silicone gel implants high and very high profile ranging from 175 cc and 350 cc. Surgical technique: the Z incision is located inside the axilla's hair area with 2cm each leg of the Z. The skin is moved by traction superiorly towards the pectoralis muscle margin, and then the skin and subcutaneous are incised. The dissection is done from the upper pole until 2 cm under the inframammary crease. After placing the implant, closure is made on subcutaneous, dermis and skin leaving suction drains.

Results: The Z scar permitted a direct access which facilitated the pectoralis muscle approach and the confection of a submuscular pocket plane. It also abbreviated surgical time since no subcutaneous tunnel is needed. The scar's aesthetic result was well disguised with a 1 to 6 years follow up. Complication rate: no delayed wound healing, zero hematoma, zero infection, zero capsular contraction, 20 cases of seroma (6,17%); with a total of 10,46% complications. 3 cases (0,87%) needed reoperation. Unfavorable aesthetic result on 5,2% (17 cases): inframammary fold asymmetry (6 patients - 1,7%), implant lateralization (3 cases - 0,85%), double inframammary crease (2 cases - 0,58%), implant malposition (6 cases - 1,7%).

Conclusion: The Z axillary incision has presented a standout aesthetic result (pictures 1 and 2) along with an amplified, facilitated and shortened procedure. Moreover, it hasn't been prolonged beyond the limits planned when moved laterally by traction. It favored the inclusion of even bigger implants, a current trend, revealing to be a favorable choice for patients undergoing breast augmentation.