Backgrounds:The axillary approach has been widely used in China because of patients preference.Dissatisfactory results and complications were reported frequently, such as malpostion and hematoma.The problems for this approach are mostly the uncontrollable pocket dissecting and the risk of bleeding.To get better control in this approach and to optimize postoperative outcomes, we try to perform dual plane breast augmentation by auxiliary approach with assistant of endoscope.Methods:The submuscular pockets were separated through a 4-cm transverse incision in the axilla.The pectoralis major muscle were split from the costal margin with the help of a 10mam, 30°endoscope and endoscopic diathermy scissors.Bleeding during surgery was kept to the minimum.High-cohesive gel microtextured anatomic style silicone implants ranging in size from 185 to 315 g were placed through the axillary incision.The vacuum drains are routinely left in place for 3-5 days.Results 426 patients experienced a quick recovery benefited from both subglandular and submuscular planes.Postoperative analgesia requirements were reduced because of strength releasing of the muscle.The follow-up period was 6 to 24 months, with favorable resuits.All the patients had aesthetically natural outcome, with the nipple at the most projected part of the breast.No rippling, lateral displacement, double-bubble deformity, or muscle contraction-associated deformities were seen.There were no complications such as capsular contracture, hematoma, hypertrophic scar, and infection.Conclusions: Dual plane augmentation using textured silicon gel implant can be completed with the assistant of endoscope through the axillary incision.The technique combined the retromammary and partial retropectoral pocket locations to optimize benefits of each pocket location while limiting the drawbacks, eliminated the need for an incision on the breast, and created an incision far from the breast for completion of the procedure.Most of all, it provides accurate control of the pocket dissection and exactly control of bleeding, thus optimized outcomes of the augmentation and reduced risks of complications.