Endoscopic Transaxillary Dual-Plane Breast Augmentation: The Next Frontier in Scarless Breast Surgery
- Jul 12
- 4 min read
Insights from Jeong-Ho Seo, MD, PhD
Department of Plastic Surgery, Yoonho Hospital, Seoul, Rep. of Korea
Four-Year Clinical Experience
Introduction
Modern breast augmentation is no longer defined solely by implant selection. Today's patients seek natural contours, rapid recovery, and increasingly, minimal or invisible scarring.
The endoscopic transaxillary dual-plane technique addresses all three objectives by combining the proven biomechanical advantages of the dual-plane pocket with the precision of endoscopic surgery. In his four-year retrospective study, Dr. Jeong-Ho Seo demonstrated that this approach can achieve excellent aesthetic outcomes, high patient satisfaction, and a remarkably low complication rate when performed in appropriately selected patients. This article explores why the technique continues to gain attention among aesthetic breast surgeons. Surgical Technique Unlike traditional transaxillary augmentation, endoscopic surgery allows surgeons to create the implant pocket under direct magnified visualization. Key steps include:
Surgical Step | Clinical Advantage |
4–5 cm incision within the axillary crease | No visible scar on the breast |
Endoscopic dissection | Superior anatomical visualization |
Precise release of the pectoralis major | Predictable dual-plane pocket |
Bipolar haemostasis | Reduced bleeding and improved pocket clarity |
Implant insertion through the axilla | Preserves breast aesthetics |
Rather than relying on blind dissection, surgeons can accurately identify anatomical landmarks, minimise tissue trauma, and optimise implant positioning.
Why the Dual-Plane Technique Still Matters The dual-plane concept remains one of the most versatile implant placement techniques because it combines the strengths of both submuscular and subglandular augmentation. Clinical Benefits
Benefit | Why It Matters |
Muscle coverage superiorly | Reduces implant visibility and rippling |
Glandular coverage inferiorly | Improves lower pole expansion |
Better implant support | More natural breast contour |
Improved soft tissue coverage | Better long-term aesthetics |
The incision determines where the scar is placed, but the implant pocket ultimately determines the quality and longevity of the aesthetic result.
How Endoscopy Changes the Equation Historically, the transaxillary approach was criticised for limited visibility and inconsistent pocket creation.
Endoscopic technology has fundamentally changed this by enabling:
Direct visualization of critical anatomy
Accurate pocket dissection
Precise haemostasis
Reduced tissue trauma
Improved reproducibility
These advantages allow surgeons to perform anatomically precise surgery while preserving the cosmetic benefit of a scar-free breast.
Clinical Experience from Dr. Jeong-Ho Seo's Study The study reviewed 58 consecutive patients who underwent endoscopic transaxillary dual-plane breast augmentation over four years.
Clinical Outcomes
Outcome | Result |
Patients | 58 |
Major complications | 0 |
Overall complications | 1 (1.7%) |
Patient satisfaction | 57/58 patients |
Hospital stay | Discharged on postoperative Day 1 |
These findings support the safety and reproducibility of the technique when performed by experienced surgeons.
Understanding the One Complication
The study reported one patient who developed inferior pocket closure, resulting in superior implant displacement.
Rather than classic capsular contracture, fibrosis within the lower implant pocket gradually reduced the available space, causing the implant to migrate upward. Revision surgery was successfully performed using endoscopic inferior capsulotomy through the original axillary incision, preserving the cosmetic outcome.
The case highlights the importance of careful postoperative follow-up and demonstrates that endoscopic revision surgery can effectively address selected complications.
Patient Selection Is Key
Ideal candidates include:
Primary breast augmentation patients
Mild to moderate breast ptosis
Patients prioritising scar concealment
Individuals with realistic expectations
Patients requiring significant mastopexy or complex revision surgery may be better suited to alternative surgical approaches.
The Learning Curve Cannot Be Ignored
Despite encouraging outcomes, endoscopic transaxillary augmentation remains technically demanding.
Successful adoption requires:
Thorough understanding of breast anatomy
Experience with endoscopic techniques
Consistent surgical methodology
Appropriate patient selection
Technology enhances precision, but excellent outcomes still depend on surgical expertise.
Looking Ahead
As endoscopic imaging, surgical instrumentation, and preoperative planning continue to evolve, scar-conscious breast augmentation is likely to become increasingly refined.
Future advances may further improve:
Pocket precision
Recovery time
Implant positioning
Long-term aesthetic outcomes
Endoscopic transaxillary dual-plane augmentation is well positioned to remain at the forefront of minimally invasive aesthetic breast surgery.
Conclusion
Dr. Jeong-Ho Seo's four-year experience demonstrates that endoscopic transaxillary dual-plane breast augmentation is more than simply an alternative incision technique. By combining enhanced visualization with the biomechanical advantages of the dual-plane pocket, surgeons can achieve predictable implant positioning, low complication rates, high patient satisfaction, and the aesthetic benefit of avoiding visible breast scars.
While larger prospective studies are still needed, current evidence suggests that, in experienced hands, this technique represents an important step forward in modern scar-conscious breast augmentation. Reference:
Seo, J.-H. (2018). Endoscopic transaxillary dual-plane breast augmentation: A four-year retrospective clinical study. Journal of Cosmetic Medicine, 2(2), 96–99. https://doi.org/10.25056/JCM.2018.2.2.96
Explore the latest natural breast enhancement innovations with South Korea's renowned breast surgery experts this August:
IFAAS Mini Fellowship (In OR Observation)
Korean Advanced Aesthetic Breast Augmentation & Breast Lifting
27-28 August, 2026 - Seoul, South Korea - [Register Now]
More Upcoming Global Events
Comments