Subfacial Breast Augmentation: What is it?

Rian A. Maercks, MD
Article by
Miami Plastic Surgeon

Most commonly surgeons pick ‘below the muscle’ or ‘above the muscle’ positioning when using breast implants. ‘Above the muscle’ augmentations usually look the most natural initially but quickly age especially when a large size is chosen. Quickly the upper pole of the breast looses volume and becomes a silhouette of the implant, in the lower pole the implant is usually very palpable and with capsular contracture, a ‘rock in a sock appearance’ may result.

Implants placed under the muscle have the advantage of using the muscle for some upper pole fullness and hiding the implant. Under the muscle augmentations look less natural and have the tremendous downside that every time a woman moves her arms the implant can change shape, drawing attention to the unnatural form.

Subfacial augmentation avoids the major drawbacks of the two former techniques and has several advantages. The pectoral fascia is a thin but very strong layer of tissue directly above the pectoralis major muscle. In 1998 Dr. Ruth Graf, a talented and internationally famous Brazilian plastic surgeon, developed the subpectoral augmentation technique. The concepts which have now withstood the test of time include a internal brassiere of fascia that participates in carrying the load of the implant. By having a structural support, the breast is protected from accelerated aging from implant load. The intact structure also results in a beautiful distribution of natural breast parenchyma over the superior pole of the implant, blunting the edge of the implant and creating a much more natural appearance.

Having trained with Dr. Ruth Graf, I preferred technique for breast augmentation is subfacial with transaxillary (through the armpit) access. In this manner a beatifully natural appearing breast is created with no distracting scars!