Trans-axillary breast augmentation: a Randomized Controlled Trial comparing a new semi-endoscopic video-assisted technique versus the blind technique.

[BACKGROUND] The pursuit of optimal aesthetic outcomes in breast surgery has led to the evolution of various surgical techniques. The trans-axillary approach for breast surgery leads to a high patient satisfaction due to its aesthetic advantage of avoiding visible scars on the breast. [1] This approach was firstly described by Hoechler in 1973.[2]It is particularly used in procedures such as breast augmentation and more recently in reconstructive surgery after breast cancer, where achieving an optimal cosmetic outcome is crucial. The aim of our study is to compare the trans-axillary blind approach with our new "semi-endoscopic" video-assisted trans-axillary approach analyzing the benefits and limitations of each method.

[METHODS] A total of 118 patients were randomized to either the trans-axillary blind approach or the semi-endoscopic video-assisted trans-axillary approach for breast augmentation, from April 2019 to December 2022.

[RESULTS] The results indicate that the semi-endoscopic video-assisted approach was associated with a lower incidence of complications such as asymmetries, attributed to bottoming out, double bubble and breast animation deformity, as well as capsular contracture even if it requires longer operative times.

[CONCLUSIONS] This randomized trial shows the advantages and limitations of each technique, highlighting how the endoscopic assistance could significantly help improving surgical outcomes while maintaining an acceptable surgical time.