Five-Year Outcomes of Breast Augmentation with Form-Stable Implants: Periareolar vs Transaxillary

Aesthet Surg J. 2017 Jan;37(1):46-56. doi: 10.1093/asj/sjw154. Epub 2016 Sep 30.


Background: Form-stable 410 implants have the potential advantage of maintaining their anatomic form thanks to the cohesiveness of the gel. Furthermore, Biocell texturing appears to maximize adhesion and to allow for implant immobility.

Objectives: To compare the rate of reoperations for transaxillary and periareolar approaches for breast augmentation.

Methods: This retrospective study consisted of 373 patients with a 5-year follow up. Patient demographics, self-perception and esteem, surgical technique, and implant characteristics were documented. The reasons for reoperation for both approaches were reviewed.

Results: Transaxillary breast augmentation was used in 302 patients (81%) and periareolar breast augmentation in 71 patients (19%). In the axillary group, 210 had subfascial placement (69.5%), and 92 patients had submuscular placement (30.5%). In the nipple-areolar complex group, 50 were subfascial (70.4%), and 21 were submuscular (29.6%). The reoperation rate for the patients operated on during this time and followed for 5 years was 11% (8 patients) for the nipple-areolar complex approach and 8.3% (25 patients) in the axillary group. Capsular contracture grade III or IV were the main causes for reoperation for any technique (4.2% nipple-areolar complex vs 3.3% axillary). Other reasons were implant rupture, seroma, infection, implant malrotation, implant malposition, and rippling.

Conclusions: The rate of reoperations was similar to those described in the literature for this type of implant. There were no statistically significant differences between the various techniques, although the reoperation rate was significantly higher when a periareolar subfascial technique was used.

Level of evidence: 3 Therapeutic.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Breast / surgery*
  • Breast Implantation / adverse effects
  • Breast Implantation / instrumentation*
  • Breast Implantation / methods*
  • Breast Implants*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Middle Aged
  • Patient Satisfaction
  • Photography
  • Postoperative Complications / etiology
  • Postoperative Complications / surgery
  • Prosthesis Design
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • Young Adult