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Breast preservation has become one of the latest phrases used to promote breast augmentation. It sounds reassuring, but the term alone tells you very little about how an operation is actually performed.
What is being preserved? The breast skin? Glandular tissue? Supporting ligaments? Muscle? Sensation? Or simply the size of the incision?
These are different considerations. A small incision does not automatically mean that the breast itself has been left undisturbed. Patients need a clear explanation of where the incision is placed, which tissue layers are crossed, where the implant sits, and how the surgeon creates the implant pocket.
That is where the distinction between newer “preservation” procedures and endoscopic breast augmentation becomes important.
Breast tissue preservation is an evolving concept in aesthetic breast surgery. In general, it refers to surgical planning and techniques intended to limit unnecessary disruption of the breast’s natural tissues and supporting structures.
The idea has merit. I have always believed that surgeons should preserve normal anatomy whenever possible. The disagreement is over what qualifies as preservation.
Some newer breast augmentation methods use a short incision beneath the breast. A narrow instrument creates a pathway into the breast, and an inflatable device may be used to separate or stretch the tissues before the implant is inserted. The implant is generally positioned above the pectoral muscle in a prepectoral, subglandular, or proposed subfascial pocket.
That may be a less-invasive option for carefully selected patients, but the terminology deserves scrutiny. The incision is still placed on the breast, and the surgical pathway still enters the breast area to create the pocket. Calling the operation “preservation” does not change those anatomical facts.
Every breast augmentation affects tissue to some degree. An implant needs an incision, an access route, and a precisely created pocket. The meaningful question is not whether a procedure carries the preservation label. It is exactly what the surgeon does after making the incision.
Patients understandably pay attention to incision length. It is easy to compare a two-centimeter incision with a four-centimeter incision and assume that the shorter one must be less invasive.
Surgery is not that simple.
The location and internal path of the incision matter just as much as its length. A small incision on the breast may still require the surgeon to pass through or separate breast tissues. Conversely, an incision positioned away from the breast can provide access to the implant pocket without using the breast skin or glandular tissue as the surgical entry route.
This is why I encourage patients to look beyond the marketing language. Ask what structures are encountered, how the pocket is created, whether the surgeon can see the anatomy during dissection, and where the permanent scar will remain.
Endoscopic breast augmentation is a transaxillary approach, meaning the operation is performed through an incision concealed within the underarm.
In the technique I use, an incision measuring less than one inch is placed within the hair-bearing portion of the axilla. A small endoscopic camera is introduced through that opening, allowing me to view the internal anatomy on a magnified operating-room monitor.
I can see the pectoral muscle, its attachments, the chest wall, and small blood vessels as I create the implant pocket. The implant is then placed beneath the muscle through the same underarm incision.
The breast skin and glandular breast tissue are not used as the access path. There is an incision and therefore a scar, as there is with every operation, but that scar is positioned in the underarm rather than on the breast.
This is the central difference. Endoscopic breast augmentation does not simply make the breast incision shorter. It moves the incision off the breast.
My approach is known as TEAM, or Transaxillary Endoscopic Augmentation Mammoplasty.
TEAM combines an underarm incision with direct endoscopic visualization. In appropriate patients, the technique is designed to provide muscular coverage over the implant while allowing precise control of the implant pocket.
The camera is not a minor addition. Older transaxillary operations were sometimes performed with blunt dissection and limited visibility. Endoscopy changes that. Instead of attempting to create the pocket by feel, the surgeon operates while viewing the relevant anatomy directly.
This visibility helps with controlled muscle release, pocket dimensions, implant positioning, and management of small blood vessels. It also allows silicone or saline implants to be placed through the transaxillary approach, depending on the patient’s anatomy and goals.
I performed my first endoscopic breast augmentation in 1993 and have taught endoscopic techniques to plastic surgeons around the world since the 1990s. The method is established, but it remains technically demanding. A surgeon must understand both breast anatomy and endoscopic surgery to perform it consistently.
I do not market my operation as “preservation breast augmentation.” I call it what it is: endoscopic breast augmentation.
However, if preservation means avoiding an incision on the breast and avoiding the use of breast parenchyma as the surgical access route, the endoscopic approach has followed those principles for decades.
We enter through the underarm, create the pocket beneath the muscle under direct visualization, and place the implant without making an incision on the breast itself.
That is a concrete anatomical distinction. Patients can understand it, surgeons can demonstrate it, and it does not depend on a fashionable label.
Every surgical incision produces a scar. Claims of completely “scarless” surgery should always be understood in that context.
Endoscopic breast augmentation leaves a short scar in the underarm. It does not leave a surgical scar on the breast, around the areola, or within the fold beneath the breast.
For patients with smaller breasts or limited natural tissue, an inframammary scar may be more visible because there is not a deep breast fold to conceal it. Positioning the incision in the axilla keeps that scar away from the breast’s visible aesthetic surface.
Scars also heal differently from one patient to another. Skin type, genetics, sun exposure, tension, smoking, and postoperative care can all affect the final appearance. The goal is to place the necessary incision in a discreet location and manage it carefully throughout healing.
Many patients seeking primary breast augmentation may be candidates for an endoscopic transaxillary approach. A consultation is still necessary because the operation must be planned around the individual patient rather than the name of a technique.
I evaluate:
Breast implants add volume, but they do not reliably correct substantial breast descent. A patient who needs a breast lift will require breast incisions because skin must be removed and the breast tissues repositioned. Previous operations, significant pocket problems, or certain revision procedures may also influence the recommended incision.
The right approach is the one that fits the anatomy and the operation that actually needs to be performed.
No breast augmentation technique eliminates the risks associated with surgery or breast implants. “Preservation,” “minimally invasive,” and “endoscopic” should never be interpreted as “risk-free.”
Potential concerns include bleeding, infection, changes in breast or nipple sensation, asymmetry, implant malposition, capsular contracture, visible rippling, rupture, and the possibility of future surgery. Breast implants are not lifetime devices, and patients need an appropriate plan for long-term monitoring.
The incision is only one part of a responsible breast augmentation discussion. Implant type, implant surface, pocket location, tissue coverage, future imaging, recovery, and possible complications all deserve equal attention.
If a surgeon recommends a “preservation” or minimally invasive breast augmentation, ask for specific answers:
A good consultation should make the operation easier to understand. You should leave knowing what the surgeon intends to do and why, not simply remembering the name of a branded procedure.
Plastic surgery is full of changing terminology. Terms such as “preservation,” “deep plane,” and “minimally invasive” can describe legitimate surgical ideas, but they can also be used so broadly that they stop providing useful information.
Do not choose an operation because the language sounds modern. Ask the surgeon to explain the anatomy.
At Core Plastic Surgery, we have used the endoscopic transaxillary approach for decades because it gives us direct visualization, keeps the incision off the breast, and avoids using the breast tissue as the surgical access route. We call it endoscopic breast augmentation because that accurately describes the procedure.
If you are considering breast augmentation in Birmingham or traveling to Alabama for an endoscopic procedure, contact Core Plastic Surgery to schedule a consultation with Dr. Grady Core. We will evaluate your anatomy, discuss your implant options, and explain which surgical approach makes sense for you.
We are happy to answer any questions you may have and get you on your way to beautiful, natural-looking results. Contact us.
3595 Grandview Parkway, #150, Birmingham, AL 35243