This technique has provoked many controversial comments. With modification and adequate clinician training and experience, however, the results can improve, and complications can be minimized. The author's complications occurred in the early stages of the use of this method; as experience was gained, they decreased. Furthermore, fewer and less severe complications occurred when the techniques were modified, including using instrument dissection before tissue expansion, better patient selection, early massage, and more frequent postoperative follow-up visits. In addition, this method leaves no scar at the breast and allows a quicker recovery. Most patients who underwent this procedure have been pleased with their results. Transumbilical endoscopic bilateral augmentation mammaplasty is an attractive alternative technique, and with careful patient selection, operative modification, and technical expertise, results can be achieved comparable with an open subglandular augmentation.