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

Abstract

Background: 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 addressed scars utilizing scar-specific instruments.

Objectives: The primary outcomes were axillary incision evaluation and complications.

Methods: We identified a cohort of patients who underwent TAA BA. Scar outcome was evaluated using the POSAS v2.0 at 1, 6- and 12-months study endpoints.

Results: The cohort contained 71 patients (mean 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 one complication, most frequently axillary banding (4.2%). Mean axillary incision length was 37.1 mm (range: 25-66 mm). Non-use of implant sleeves (p<0.001), textured-surface implants (p<0.001) and implant volume >350 cc (p<0.001) were associated with larger incisions. At 12 months the poorest scores were related to color (2.35,1-6), 81 and 78.2% of patient and observer opinion scores were low/intermediate grade, respectively. Textured-surface implants (p<0.001), implant volume>350cc (p<0.001), non-use of sleeve (p<0.001) were significant risk factors for high/very-high POSAS overall scores in one 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. Our data demonstrate that the TAA is a reliable technique, and evaluations using the POSAS tool showed that most patients presented satisfactory results and higher satisfaction with lower POSAS scores at 1-year post-surgery. Adequate preoperative planning and incision placement allows surgeons to perform this technique safely while minimizing risks of poor scar outcome.