The transaxillary approach to breast augmentation provides patients with an option for augmentation that avoids any visible scars on the breast. The versatility of the endoscopic technique allows the surgeon to reliably dissect the submuscular pocket under direct visualization and to control the position of the inframammary fold while still enabling the use of any of a wide variety of both saline and silicone implants. This article addresses issues related to patient selection and preoperative assessment of this technique as well as technical aspects of performing this operation. In addition, the article reviews postoperative management of the endoscopic augmentation patient and describes potential complications associated with this technique.