Phillip Nunnery MD
Interesting ?! The majority of plastic surgeons utilize the subpectoral (biplanar) position for breast implants due to studies that reflect a lower capsule contracture rate than subglandular position. The Subfascial position which I assume you mean under the pectoralis fascia but on top of the muscle (which I've never done) could possibly cause more bleeding. So I don't see the advantage. Subglandular position of implants have been long used by surgeons, but fell out of favor due to studies showing increased risk of capsule contracture vs. subpectoral position. Having said that, more recent studies have shown that smooth wall implants have a higher rate of capcon that texturized implants. I bet in near future we will see a gradual swing back to using the subglandular postion with Generation 5 textured Shaped implants made by Sientra.
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What are your thoughts on the success of sub facial or sub glandular implant placement ?
There is not a great benefit for sub facial that can be clearly demonstrated and the surgery is not as straight forward as subglandular. Both locations do have a higher capsular contracture rate than bi-planar.
See no advantage in some fascial placement of breast implants.
Most breast implants particularly silicone gel do quite well in a sub glandular position. It is less painful and they are not displaced by motion of the pectoralis muscle. Some fascial placement is painful with any particular advantage that I see.
Subfascial breast implants
The subfascial breast implant attempts to place the implant under the fascia (covering) of the pectoral muscle directly behind the breast.
I have done this approach.
Why? Lifting the fascia causes considerable bleeding, pain after surgery and the fascia is inflexible so the implant doesn't fit easily under it - so it usually turns into a subglandular implant.
The 'advantage' of the subfascial is the claim that it reduces infection after breast lifts.
The evidence I have seen is not convincing.
The two standard approaches for breast implants are to put the implant either under the pectoral muscle or over the muscle, under the breast. Best wishes.
Subfascial implant placement
In my opinion there are two sites for implant placement: over the muscle (subglandular) and partially beneath the muscle (dual plane). Placing the implant subglandular including the fascia offers no benefit. It could prolong surgery, increase pain and increase bleeding.
Subfascial and subglandular implant placement
Many surgeons will talk about a subfascial implant position as being a happy medium between a subglandular and subpectoral pocket. Implants placed in the subglandular or over the muscle position are much more likely to be palpable and possibly visible with wrinkling and rippling through the skin. I also have seen that subglandular implants are more likely to stretch out the skin between the nipple and the crease of the breast over time. Implants placed under the muscle will have some animation deformities of the chest when the pectoralis muscle is flexed. It does provide better coverage of the implants and the capsular contracture rates are much lower when placed under the muscle. The subfascial positioning is really just a subglandular pocket, in my opinion, and is more of a marketing term than anything.
Subpectoral Vs. Subfascial Vs. Subglandular #breastimplant augmentation
The question of where to put implants during breast augmentation is one of the core points of a good consultation. In certain instances, there is a benefit to each location. The subfascial location is under a thin but tough layer of tissue just above the muscle. This is very similar to the location with subglandular placement. Enough so that the two can be thought of as the same place. Both, however, are different from submuscular or below the muscle placement.
There is not a correct or incorrect place to put an implant. In each case, the placement depends upon the individual, the goals of the operation and the problems that are being addressed. For example, An implant in the subfascial or subglandular position can provide a little bit of a lift but in very thin women can lead to the implant being visible or able to be felt. An implant in the submuscular position has less issues with these things but requires the patient to tolerate the specific risks of implants beneath the muscle (mostly that the muscle is cut and that the muscle can cause the implant to move out to the side).
This is a wonderful site for addressing some questions, and I hope you get some more information, but this is exactly the kind of thing that most plastic surgeons build a consultation around. Hopefully you can find someone you like and trust in your area to help you through the process.
Placement of Breast Implant
There are many factors that go into the decision on the placement of a breast implant. In general, a subglandular implant (above the muscle) may be associated with less "down-time" and increased cleavage. However, it requires that you have enough breast tissue to camoflauge the implant. It may be associated with a slightly higher risk of capsular contracture, however. A submuscular implant is often preferred if you do not have a significant amount of breast tissue to begin with. It may be associated with a slightly lower risk of capsular contracture. Because of these, and many other factors, it is important that you personally consult with a board-certified Plastic Surgeon.
Every surgeon has their preference for implant placement. I prefer the dual plane technique as I feel it facilitates a natural breast shape in many different body types. Please visit with a board certified PS to learn more about what's right for you.
Sub Pectoral Breast Implant Placement
I use almost exclusively a sub pectoral placement for breast implants as it tends to look and feel much more natural.
When considering breast augmentation surgery, look at many photos from many perspectives and carefully check the credentials of your plastic surgeon.