Résumé de communication

Objectives: The endoscopically assisted Transaxillar Breast Augmentation (EATBA) is usually favored over the “blind” Transaxillar Breast Augmentation (BTBA) because of the visual control over the dissection and hemostasis thus presuming that these two are the same surgeries in all other respects. This presumption means misunderstanding of principal features of these two operations which certainly need to be elucidated. Introduction: Understanding the differences between BTBA and EATBA helps a lot in explaining and therefore avoidance of complications pertinent exclusively to one or another. The differences encompass all steps beginning with markings and finishing with postoperative treatment. Herewith we talk about subpectoral implant pocket only. Materials / method: Tumescent infiltration of anesthetic + Adrenalin 1:400 000 is mandatory to BTBA, whereas it is not generally agreed in EATBA, because electrocautery may not work in water. In EATBA dissection stops in subcutaneous tissue at the new IMF level precisely determined by the puncturing needles, while in BTBA dissection stays below the deep fascia and has to go 2 – 3 cm caudad to the planned IMF. In EATBA the pocket is geometrically predetermined by markings, while in BTBA dissection should extend beyond the desired footprint. In EATBA the breast is “finished”, while in BTBA it needs further control. Results: The main concern about BTBA is hemostasis which proved unjustified as we never did emergency revisions in about 500 cases, while in other approaches we do so at least once a year or about 1%. The early postoperative bruising is the same in all approaches. The major late EATBA complication was high-riding implant, whereas in BTBA it was the lower-lateral or lower-medial implant displacement. Recently this issue has been solved efficiently by prolonged outer compression. Conclusion: The principal difference in BTBA and EATBA design, markings, implementation and postoperative dynamics should be well appreciated for the sake of understanding and proper dealing with the consequences.