The female breast has been considered as one of important characteristics of femininity. Many women with small breast may be shy and withdrawn. A lack of self confidence and feeling of inadequacy may result from small breast and some women become so emotionally concerned with their small breasts that it is difficult for them to assume a normal role in courtship and marriage life. So the plastic surgeon's goal for breast augmentation is the creation of attractive, symmetrical breasts that coincide with the patient's desires for breast size and are in proportion with her other features.
  From January 1994 to March 1997, we experienced 45 women (90 breasts) whose breast was hypoplastic and followed up 21 months in the mean. All patients were operated with endoscopically assisted transumbilical augmentation mammoplasty that had been introduced by Johnson and Christ in 1992. Also we develped unique technique that made it possible to insert the breast implant under the pectoralis major muscle through the umbilical approach in November 1995. We have confronted several problems intraoperatively and postoperatively. These includes implant rupture during operation(1 case), and after operation(1 cases), leakage of inflated saline(1 case), remaining breast ptosis(1 case), asymmetry(2 case), capsular contracture(5 cases), abdominal wall hematoma(1case), and breast hematoma(1 cases). Of these the incidence of capsular contracture is higher than other complications. To reduce the incidence of these problems, in our opinion, several preconditions are met as follow : (1) preoperative discussion with patients and thorough analysis and plan; (2) colse examination and careful manipulation of breast implant; (3) aseptic, atroumatic, and bloodless procedures; (4) placement of breast implant under pectoralis major muscle; (5) acquisition of extensive dimension of implant pocket over 200% and sufficient dissection of inferomedial aspect of muscle; (6) postoperative close observation, patient's cognition, and self-management.
  The purpose of this study is to present our experience with augmentation mammoplasty, the frequency with which we have encountered the problems, and the current techniques employed to minimize the problems.