The Endoscopic Breast Augmentation

Why We Keep Scars Off the Chest

Dr. Grady Core

This February, I had the privilege of attending the American Brazilian Aesthetic Meeting in Park City, Utah. Surgeons from all over the world gathered to review the latest clinical data. The most interesting takeaway from the conference wasn't a new implant technology or a radical new theory. It was a realization.

The industry is finally catching up to a surgical protocol we established decades ago. People are finally starting to do endoscopic breast augmentations.

I performed my first endoscopic augmentation in 1993. For over 30 years, I have never understood why surgeons default to putting incisions directly on a patient's chest when it is completely unnecessary. Anatomy dictates the surgery, but surgical technique dictates the footprint you leave behind. Here is the clinical reality of the endoscopic approach, the new data on complication rates, and why we refuse to leave visible scars on the breast.

What is an endoscopic breast augmentation?

An endoscopic breast augmentation is a surgical technique utilizing a 4mm camera inserted through a tiny incision deep in the underarm (axilla). This allows the surgeon to precisely dissect the tissue and place the breast implant without leaving any surgical scars on the breast itself.

The camera changes the surgical mechanics entirely. We are not working blind. The endoscope provides high-definition, magnified visibility of the internal chest cavity on an operating room monitor. We see the muscle attachments, the ribs, and the micro-vessels perfectly.

The Scar Problem: Why the Chest Incision is a Compromise

Traditional breast augmentation relies on the inframammary fold (IMF) incision. The surgeon cuts directly into the crease under the breast.

For patients with heavy, naturally ptotic (sagging) breasts, that crease hides the scar well. But most patients seeking augmentation do not have heavy breasts. If you have very little native breast tissue and you want a natural, proportionate result, the undersurface of your breast will be visible without clothes on. There is no heavy fold to hide the incision. You are left with a permanent, visible track line sitting directly on your chest wall.

It can easily be avoided. In our Birmingham clinic, we find that 95% of patients presenting for breast augmentation are candidates for the endoscopic approach. We bypass the breast skin entirely. We make a small incision in the natural folds of the axilla (underarm). When your arms are down, the incision vanishes. When your arms are up, it looks like a natural skin crease.

The Data Shift: Debunking the Capsular Contracture Myth

If you research the axillary (underarm) approach online, you will likely encounter outdated medical warnings. For years, critics claimed that going through the underarm carried a higher risk of capsular contracture—the hardening of scar tissue around the implant.

That data is obsolete. It was based on "blind" transaxillary procedures from the 1980s. In those older surgeries, surgeons did not use cameras. They used blunt instruments to force a pocket open without seeing the internal anatomy. That blind trauma caused internal bleeding. Blood pooling around an implant is a primary trigger for capsular contracture.

The endoscope eliminates that variable. Because we operate under direct, magnified vision, we can identify and cauterize every single microvessel. The implant pocket remains completely dry.

At the meeting in Utah, a doctor from Pennsylvania presented over 700 documented cases proving this exact physiological reality. The data is definitive. The rate of capsular contracture with an endoscopic axillary approach is just as low as it is through the traditional inframammary incision. The complication rates are identical. The aesthetic outcomes are excellent. The only difference is the absence of a scar on the chest.

Surgical Execution: We Can Do Anything With a Scope

Some patients are told by other providers that an underarm approach limits their options. They are told they cannot get silicone implants or that the implant cannot be placed in the proper plane. This is factually incorrect.

The scope is simply a tool that helps a surgeon see better. There is nothing that can be done through an incision on your chest that cannot be executed through the endoscope.

• The Plane of Placement: We can put the implant in any anatomical plane required. We can go under the muscle (submuscular). We can go in front of the muscle (subglandular). We can execute a dual-plane release. We identify the origin of the pectoralis muscle and release it with absolute surgical precision.
• The Implant Type: You can use silicone. You can use saline. The endoscope accommodates all modern, FDA-approved implant profiles and materials.

The Revision Advantage: Exchanging Old Implants

Our use of the endoscope is not limited to primary augmentations.

Many patients come to us with existing implants that were placed through an axillary incision years ago by another surgeon. When those implants need to be upsized, downsized, or replaced due to age, patients assume they will need a new incision on their chest to get the old implants out.

They do not. We can perform implant exchanges and complex pocket revisions endoscopically. We enter through your existing underarm scar, use the camera to visualize the old capsule, remove the implant, modify the internal pocket if necessary, and place the new implant. We fix the issue without adding new scars to your body.

The Anatomical Comparison

The differences between the traditional and endoscopic approaches come down to visibility and permanent scarring.

The Structural Imperative

Anatomy dictates the surgery. You do not need to trade breast volume for a permanent scar on your chest.

We have over 30 years of clinical evidence proving that the endoscopic approach delivers identical safety profiles, superior visualization, and vastly superior scar management. Do not accept an incision on your chest unless it is absolutely anatomically necessary. Contact Core Plastic Surgery in Birmingham for a clinical evaluation. We will map the surgical vectors required to rebuild your anatomy without leaving the tell-tale signs of surgery behind.