Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSPMUNHOZ, Alexandre MendoncaNETO, Ary de Azevedo MarquesMAXIMILIANO, Joao2023-10-302023-10-302023PLASTIC AND RECONSTRUCTIVE SURGERY, v.152, n.2, p.264E-269E, 20230032-1052https://observatorio.fm.usp.br/handle/OPI/56240Advances in breast augmentation techniques have led to safety improvements and better aesthetic results. The concurrent combination of the axillary approach with a subfascial pocket has been suggested for augmentation procedures, because it avoids breast scarring and the limitations of submuscular positioning represented by breast animation when the pectoral muscle is contracted. With the improvement of autogenous fat grafting techniques, new implant coverage options and more natural results have been proposed with more superficial implant pockets; simultaneous autogenous fat grafting with silicone implants (defined as hybrid breast augmentation) has recently been evaluated as a promising technique. Combining these two procedures allows core volume projection and natural cleavage while camouflaging implant edges. Fat grafting is also useful in reducing intermammary distance and achieving a smaller and smoother transition between the breasts. This article and the accompanying videos provide a detailed, step-by-step guide to hybrid breast augmentation using a subfascial axillary approach, with a predictable and optimized surgical outcome.engrestrictedAccesstransaxillary approachsilicone gelimplantmammaplastythicknesssoftarticleCopyright LIPPINCOTT WILLIAMS & WILKINS10.1097/PRS.0000000000010216Surgery1529-4242