What is Cold-subfascial Placement?

Are there any surgeons in NY/NJ/Ct that use this for revision surgery?

Doctor Answers (9)

Cold-subfascial augmentation: beyond dogmatically accepatble breast augmentation and revision

+3

Several anatomic studies have been conducted and in the past 15 years demontrating the solid structural integrity of the pectoralis fascia. The morphology/shape of breast augmentations is significantly different from 'under themuscle' and 'over the muscle.' Cold- subfascial technique is indeed a modification of subfacial augmentation in which a histiocentric approach is used, avoiding electrocautery to preserve the full shaping and lasting power of the pectoralis fascia. There are many women who have been very unhapppy with other techniques who seek conversion to this less known and innovative manner of breast augmentation. To learn more please reference the developer of this technique Dr. Ruth Graf and her anatomic studies. Dr. Graf has been performing subfascial augmentation for over fifteen years and has incredible long term follow up with preservation of amazing shape. This technique is not commonly used because it is not taught in most training programs and takes more time and technical skill to complete.

All the best,

Rian A. Maercks


Miami Plastic Surgeon
5.0 out of 5 stars 31 reviews

"Cold-Subfascial" Implant Revision

+2

Dear Allie,  There are basically four "planes" in which a breast implant can be placed.  There is the subglandular pocket with the implant in between the breast and the pectoralis major muscle.  There is the subfascial pocket where the implant is placed between the fascia-a thin tissue layer on top of the pectoralis muscle-and the muscle proper.  There is the partial submuscular pocket  where the implant is placed between the pectoralis major and the chest wall.  There is the full submuscular pocket where the implant is place under the pectoralis major and the serratus anterior muscles.  There are advantages and disadvantages for each position and which one is right for you requires a consultation with a board-certified plastic surgeon.  As far as the "Cold" part of their recommendation, to my knowledge this technique has NEVER been presented at a major national meeting not has it been published in any of our peer-reviewed journals, so I like the other responders remain very suspicious of its validity.  Please ensure your plastic surgeon is board-certified and also do your homework on any procedure any doctor recommends to you before proceeding.  Remember-it is YOUR BODY.  Take care of it.  Good Luck.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.0 out of 5 stars 18 reviews

Understanding breast implant placement: under or over, subfascial, split

+2

I have used variations of subfascial placement for several years and published the first article in North America on the subject. (Fascia is pronounced like "fashion.) The fascia is a thin layer on the surface of the muscle so going under does not add much in the way of "padding" but may add some support and soften the transition from the chest into the upper part of the breast. It is therefore most similar to over the muscle/subglandular. Submuscular using the standard technique may predispose to what are called animation deformities, which can be minimized by the split muscle method, which avoids cutting the muscle attachment as it typically done. This was developed as a variation of subfascial. So there are really 4 ways to do it but like the other replies, I have no idea what the "cold" part refers to except perhaps not using cautery.

1. Baxter R. Subfascial breast augmentation: Theme and variations. Aesthetic Surgery Journal 2005;25(5):447-53.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 23 reviews

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Marketing in plastic surgery

+1

Interesting how some surgeons try to name an operation differently so that they sound unique.  Basically an implant can be placed above the muscle or below it.  No real difference in my mind exists between the above the muscle and a subfascial procedure, and "cold" may be just not using a cautery.  Mostly just marketing...

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 48 reviews

What is Cold-subfascial Placement?Answer:

+1

I don’t really know what that means, to be honest…the subfascial I get, but the cold??? Not sure. Ask for clarification and let us know!!

John J. Corey, MD
Phoenix Plastic Surgeon
4.5 out of 5 stars 16 reviews

Cold sub-fascial placement

+1

Sub fascial placement of implants is one way to place implants.  It does not make sense to me because the fascia is a very thin layer, and does not add anymore coverage than subglandular.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Give the "Cold-Subfascial" Implant Revision - the Cold Shoulder

+1

Breast implants are placed in the breast EITHER under the breast gland (submammary) OR under the breast gland and the muscle underneath it (subpectorally). Each location has its indications depending on patient features and surgeon's preferences.

As Cosmetic Plastic Surgery has become more competitive some Plastic surgeons and a lot more non-Plastic surgeons who PRACTICE Plastic Surgeons (General surgeons, Ear Nose and Throat surgeons, OB-GYN and even Family Practice doctors) who seek to disinguish themselves from their competition have gone to preposterous extremes to attract patients. Among the many ploys used is the use of impressive sounding procedures, the use of branded name procedure (IE the West Orage Lift) and qualifying any operation with the word LASER. (After all, wouldn't you rather have a LASER Breast Augmentation than just a plain old Breast Augmentation?). In the same vein, here comes the procedure you inquire about. The pectoralis muscle fascia is paper thin and placing an implant underneath it without putting multiple holes in it is not only impossible BUT offers NO advantages. But hey - it sure sounds great. But, not only is this operation performed by Dr. Wonderful amazing, but it uses a proprietrary "Cold" technique. OMG!! It must be even better than the Transoral Endoscopic Laser Gummy Bear Breast Augmentation.

Some advice; if it smells funny, do not come too close.

Peter a Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 60 reviews

What is Cold sub-facial placement?

+1

Your question is asked  in reference to revision surgery.  Like the responses posted ahead of mine, I am not familiar with this technique as the terminology may have been coined by the doctor you consulted with.  The subfacial layer  has been discussed  for its role  as a continuation of the muscle inferiorly or  the layer that allows one to  maintain  muscle(and fascial)  cover in augmentation rather than the typical partial muscle or dual plane coverage.  The sub fascial pectoral muscle layer is extremely thin to non existant inferiorly and plays little if any role in revision surgery.   There are other recognized techniques such as NeoPectoral placement which creates a new pocket below the pectoral muscle which may be a better option for you if your implant is already under the muscle.  Other options may  exist and should be considered based upon the exact problem that is present. You may wish to seek additional opinions.  Good Luck.

Beverly Friedlander, MD
Short Hills Plastic Surgeon
5.0 out of 5 stars 8 reviews

Gimmicks in Plastic Surgery

+1

Thank you for the question.

I'm not familiar with the  terminology you are using. What is its source?

You should be aware that well experienced, ethical, board-certified plastic surgeons do not need to resort to gimmicky terminology to attract patients.

Be careful!

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 710 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.