Background: Dual-plane techniques offer excellent pocket locations for breast augmentation. Traditional techniques require incisions in the inframammary or periareolar crease, which are rarely accepted in the authors' department because of visible scars on the breast. Therefore, the authors developed a transaxillary approach for dual-plane procedures using an endoscope. Methods: During a period of 36 months between April 2009 and March 2012, 89 consecutive patients with small breasts were treated surgically. They underwent transaxillary types 2 or 3 dual-plane breast augmentation as outpatients. For the axillary endoscopic subglandular tunneling approach (AESTA), a long subglandular tunnel was created along the lateral portion of the pectoralis major muscle to reach the nipple-areolar complex. The type 2 dual-plane technique was applied in 67 patients, and the type 3 technique was used in 22 patients. Results: The mean age of the patients was 37.5 years (range 31-48 years), and the mean postoperative follow-up period was 11 months (range 7-42 months). Good surgical outcomes were obtained, and the procedure was reproducible. Conclusions: The use of AESTA allowed the authors to achieve types 2 and 3 dual-plane breast augmentation through a transaxillary incision. They believe that AESTA can yield constant and satisfactory outcomes similar to the inframammary and periareolar approaches. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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