“A Systematic Review and Meta-Analysis of 11,686 Breasts Undergoing Transaxillary Augmentation: Why Leave a Trace When You Can Go Invisible?”

BACKGROUND: Breast augmentation (BA) is one of the most commonly performed plastic procedures worldwide. The transaxillary approach (TAA) has gained popularity for avoiding visible breast scars. Despite its increasing adoption in the clinical practice and technical refinements, the available evidence on safety and outcomes remains limited and heterogeneous. METHODS: A comprehensive search of MEDLINE, Embase, Scopus, Cochrane, and Web of Science databases was performed up to May 2025. Eligible studies included adult women undergoing primary BA (PBA) with silicone implants via the TAA. Primary outcomes were capsular contracture (CC) and patient-reported satisfaction. Secondary outcomes included infection, reintervention, hematoma, seroma, implant rupture, and other complications. RESULTS: Twenty-two studies comprising 5,843 patients (11,686 breasts) were included. Patient-reported satisfaction was consistently very high across all studies. Meta-analyses showed no significant differences between TAA and other incisions for CC (RR 0.73; 95% CI 0.29-1.88), reintervention (RR 0.74; 95% CI 0.41-1.34), or infection (RR 1.00; 95% CI 0.14-6.99). Within the TAA cohort, pooled incidences were low for all outcomes: CC 2.3% (95% CI 1.6-3.4), reintervention 3.3% (95% CI 1.7-6.1), and infection 0.7% (95% CI 0.4-1.2). Importantly, secondary endpoints also demonstrated uniformly favorable safety, with hematoma (1.4%), seroma (1.4%), and implant rupture (1%) occurring rarely, and no major adverse events reported. CONCLUSIONS: PBA via TAA is a safe and effective technique, with complication rates comparable to inframammary and periareolar incisions and uniformly high satisfaction.