Transaxillary Subpectoral Augmentation Mammaplasty (TASPA): A Single Surgeon's 20 Year Experience

BACKGROUND/OBJECTIVES:  The transaxillary subpectoral augmentation mammaplasty (TASPA) has not received widespread acceptance due to perceived limitations in pocket access, visualization, control and subsequent risk for postoperative complications.  Published data in the current literature do little to substantiate or refute those claims.  A retrospective chart review of a single surgeon's twenty year experience with the traditional TASPA technique was undertaken to assess the incidence of perioperative complications, implant related revisions (IRR), and total secondary procedures (TSP).

METHODS:  1775 primary TASPAs for cosmetic augmentation were performed from January 1989 through December 2008 in this surgeon's practice.  After review of the data in an office database and in patient charts, 94 patients were excluded for follow up less than one month or insufficient data.  The database and charts were reviewed for patient demographics, implant size and style, frequency of reoperation, indications for reoperation, and length of follow up.

RESULTS: The average age of the 1681 total patients included was 32.7 ± 8.1 years (range, 16-62), with average implant size of 438 ± 51 cc (range, 270-630).  Smooth saline (1043 patients), smooth silicone (631), textured saline (3), and textured silicone (4) implants were used from Allergan/Inamed/McGhan, Mentor, and Surgitek.  Mean follow up was 37.7 ± 45 months (range, 1 month-19.8 years).  Perioperative infection occurred in zero patients and hematoma in 2 patients (0.12%).  Capsular contracture occurred in 73 patients (4.3%) and required reoperation in 58 (3.5%).  Total secondary procedures (TSP) were required in 240 patients (14.3%).  When staged mastopexy was excluded (14 patients), this rate decreased to 13.4%.  4.5% (75 patients) requested reoperation for size change.  69% of reoperations were performed through the transaxillary incision.  Implant related revisions (IRR) due to capsular contracture and rupture occurred in 114 patients (6.8%).

CONCLUSION:  It is useful to categorize total secondary procedures following primary augmentation as implant related revisions and non-implant related procedures.  In this single surgeon's experience with follow up as long as 19 years, the transaxillary subpectoral approach demonstrates rates of perioperative complications and implant related revisions that are comparable or lower than published data for alternative approaches.^1-3  The transaxillary subpectoral approach is a safe technique of augmentation mammaplasty.

References

1.       Cunningham B.  The Mentor Core Study on Silicone MemoryGel Breast Implants.  Plast. Reconstr. Surg. 120 (Suppl. 1): 19S-26S, 2007.

2.       Handel N, Cordray T, Gutierrez J, Jensen JA.  A Long-Term Study of Outcomes, Complications, and Patient Satisfaction with Breast Implants.  Plast. Reconstr. Surg. 117: 757-767, 2006.

3.       Spear SL, Murphy DK, Slicton A, Walker PS. Inamed Silicone Breast Implant Core Study Results at 6 Years.  Plast. Reconstr. Surg. 120 (Suppl. 1): 8S-16S, 2007.