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Study considers transaxillary technique for high-risk patients

New research suggests that the transaxillary incision technique for breast implant exchange procedures in high-risk patients is a safe, effective, perhaps preferable option to the standard anterior approach.

Noting that attenuated soft tissue caused by radiation, anatomy or surgery can be problematic in the anterior approach, a team of plastic surgeons from Massachusetts General Hospital undertook an evaluation of the transaxillary technique. The study involved analyzing the results of the transaxillary approach for implant exchange on 16 patients — average age, just under 50 — who had multiple risk factors for compromised soft tissue. The researchers define the transaxillary implant exchange technique as the use of a standard 4-cm axillary incision, removal of the expander, judicious capsulotomy, placement of permanent implant and closure in three separate tissue layers.

The surgeons report that the technique was successful in all 16 cases. The incisions healed with no dehiscence, infection or seroma. Half the patients had received or were scheduled to receive radiation therapy. Nine had unilateral transaxillary expander exchange; seven had bilateral procedures. Median implant size was 360 cc and mean follow-up for all patients was more than two years. There were no cases of implant extrusion, capsular contracture requiring re-operation or lymphedema. Six of the patients underwent concurrent or subsequent nipple reconstruction.

“This approach illustrates application of a technique commonly used in breast aesthetic augmentation to address a common reconstructive dilemma,” the authors write. “We believe [the approach] to be a useful tool in prosthesis-based breast reconstruction, especially in patients with compromised soft tissue envelopes.”

The study appears in the December issue of the Journal of Plastic, Reconstructive and Aesthetic Surgery.

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