The endoscopic technique: how the pocket is made under a camera
The transaxillary route earned a poor reputation in the era of blunt dissection, when the pocket was made by feel and implants rode high. Endoscopy replaced feel with vision. Here is what the camera changes, step by step.
- Incision: 3–5 cm in the deepest armpit crease, hidden when arms are down.
- Tunnel: a subcutaneous path from the armpit to the lateral edge of the pectoralis muscle.
- Pocket under vision: an endoscope lets the surgeon dissect beneath the muscle and release its lower fibres precisely at the planned fold.
- Implant: inserted through a sterile funnel (silicone) or filled in place (saline), then positioned and checked for symmetry.
- Closure: layered, with the skin line tucked into the crease; no drains in most cases.
Step 1 — planning and marking
Standing, the day before: the fold line where the implant's lower edge will sit is marked on the breast, the pocket boundaries drawn, and the armpit incision placed in the deepest crease so it disappears with the arm down. Base width and projection are confirmed against your measurements.
Step 2 — the incision and tunnel
Under general anaesthesia, the crease incision is made and a tunnel is developed under the skin toward the outer edge of the pectoralis major. This is the only part of the operation done without the camera, and it stays well clear of the armpit's lymph nodes and nerves.
Step 3 — the pocket, under vision
The endoscope enters through the tunnel. On the screen, the surgeon lifts the muscle, dissects the pocket beneath it, and releases the muscle's lower attachments exactly at the marked fold — the step that blunt technique could never do precisely, and the reason older transaxillary implants sat high and tight. With a dual-plane pocket, the upper implant is under muscle (for cover and a natural slope) and the lower pole sits under breast tissue (for fullness and a natural fold). Bleeding points are controlled under vision; the pocket is irrigated.
Step 4 — the implant
A sterile funnel delivers the silicone implant through the incision without hand contact — smaller incision, less implant stress, lower contamination risk. Saline implants pass empty and are filled in place. Position and symmetry are checked sitting up before closure.
Step 5 — closure and the first days
Layered closure with the skin line tucked into the crease. Drains are rarely needed. A surgical bra and a light upper-chest band hold the implants in position while the pocket heals; arms stay below shoulder height for 10–14 days. The recovery timeline continues from here.
The question to ask any clinic: 'Is your transaxillary augmentation endoscopic?' If the answer is no — or vague — the pocket is being made by feel, and the risk of a high-riding implant and a second operation rises. Vision is the technique; the armpit is only the door.
Questions patients ask
Blunt technique makes the pocket by feel with instruments; endoscopic technique makes it under direct camera vision, releasing the muscle precisely at the fold and controlling bleeding. Endoscopy is the modern standard.
Yes — the endoscope allows the muscle's lower attachments to be released precisely, which is what creates the dual-plane pocket. It is the most common plane used through this route.
Typically 1.5–2 hours — slightly longer than an inframammary augmentation because of the endoscopic dissection.
Free consultation with Dr. Erdal
Send your photos on WhatsApp · Direct surgeon access · Honest recommendation within 24 hours
WhatsApp Dr. Erdal