Total muscle coverage of a breast implant is possible through the transaxillary approach.

In breast augmentation through the transaxillary subpectoral approach, previous studies have indicated that the implant was only covered by muscle to the upper third of its surface. In my experience with our method of dissection of the implant pocket, I had come to a different opinion about muscle coverage of the implant. In order to confirm the position of the implant, I have undertaken an anatomic study in 10 fresh female cadavers. A transaxillary subpectoral breast augmentation was performed, followed by an anatomic dissection of both sides. In all 20 implantation sites, it was found that the implant was totally covered by muscle. The muscles involved were the pectoralis major, serratus anterior, and obliquus abdominis externus. These findings have been confirmed in the clinical setting by endoscopic photographs. Since it is documented that total muscle coverage produces fewer capsular contractures, as well as fewer steroid-related complications, and considering the superior position of the scar, I today consider this approach to be most useful.