Scar Perception and Outcomes After Transaxillary Breast Augmentation: A Prospective Analysis of Patient- and Observer-Reported Scar Quality

Abstract Background The transaxillary (TAA) approach offers breast augmentation (BA) with inconspicuous scarring. Previous investigations of scar outcomes have involved limited follow-up/samples, and no clinical studies have specifically assessed scars with scar-specific instruments. Objectives The primary aim of this study was to evaluate axillary incision and associated complications with TAA BA. Methods A cohort of patients who underwent TAA BA was identified. Scar outcome was evaluated with the Patient and Observer Scar Assessment Scale (POSAS) v. 2.0 at 1-, 6-, and 12-month study endpoints. Results The cohort contained 71 patients (mean [standard deviation] age, 28.1 [6.1] years) and 142 axillary incisions, with average follow-up of 58.3 [28.6] months. Eleven patients (15.4%) experienced at least 1 complication, most frequently axillary banding (4.2%). The mean axillary incision length was 37.1 mm (range, 25-66 mm). Nonuse of implant sleeves (P < .001), the use of textured-surface implants (P < .001), and implant volume >350 cc (P < .001) were associated with larger incisions. At 12 months the poorest scores were related to color (mean, 2.35; range, 1-6), and 81% and 78.2% of patient and observer opinion scores were low/intermediate grade, respectively. Textured-surface implants (P < .001), implant volume >350 cc (P < .001), and nonuse of sleeve (P < .001) were significant risk factors for high/very-high POSAS overall scores at 1-year follow-up. Conclusions Despite extensive research on BA procedures, studies on the TAA are limited and have not analyzed long-term incision-related outcomes. The data obtained in this study demonstrate that the TAA is a reliable technique, and POSAS evaluations showed that most patients presented satisfactory results and higher satisfaction with lower POSAS scores at 1 year postsurgery. Adequate preoperative planning and incision placement allows surgeons to perform this technique safely while minimizing risks of poor scar outcome. Level of Evidence: 4 (Therapeutic)