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How Effective is Sub-fascial Implant Placement?

asked 2 years ago by g1 in San Diego, CA
Latest answer by Steven Wallach, MD
Question viewed 1,061 times
Tags: placement, subfascial "inner bra"

I've been considering silicone breast implants for a while now and am concerned about muscle atrophy, interference, pain after surgery, etc. with subpectoral placement.

How well does sub-fascial placement work, and are there any Plastic Surgeons in San Diego experienced in this technique?

16 answers to How Effective is Sub-fascial Implant Placement?

Sub fascial impalnt placement

A sub-fascial breast impalnt placement in my opinon does not add anything to the results. It does not offer the coverage that a submuscular implant does, and it really is no better than a subglandular pocket.

Steven Wallach, MD
Manhattan Plastic Surgeon

Sub-fascial placement of Breast Implants

Hi there- There are two things to discuss here... Whether sub-fascial placement of implants really has any benefits, and why you are so worried about sub-pectoral placement... The only surgeons I know advocating the sub-fascial pocket are surgeons outside the US whose patients usually want very small implants- and even in these women, the outcome is exactly what you would expect in a sub-glandular position (on top of the muscle), with less upper pole coverage of the implant. I personally believe more

Armando Soto, MD
Orlando Plastic Surgeon

www.DrArmandoSoto.com

Sub fascial placement for breast implants not good choice.

Hi. Breast implants can be placed over the pectoral muscle, under the pectoral muscle, or partially under the pectoral muscle (dual plane approach). One of these three will give you a good result, depending on your anatomy. The muscle doesn't atrophy.

George J. Beraka, MD
Manhattan Plastic Surgeon

Subfascial breast augmentation

Subfascial breast augmentation was developed as a happy medium between subglandular and subpectoral. You'll see various opinions on this, but in my opinion it really doesn't offer significant advantages because the breast fascia is very flimsy, and therefore does not provide meaningful coverage to the implant. Subpectoral augmentation, in experienced hands, does not need to be very painful or difficult. Good luck, /nsn.

Nina S. Naidu, MD
New York Plastic Surgeon

Sub-fascial implants

There are really very poor studies in this placement approach. Also the anatomic aspects of this idea are very uncertain. I would consider this an above the muscle placement. From MIAMI

Darryl J. Blinski, MD
Miami Plastic Surgeon

Subfascial breast implant

It is often advantageous to place an implant under the muscle especially in thinner patients who do not have much breast tissue. However in those who have some breast tissue, I perform subfascial implant placement for 2 reasons: 1) to enhance longavity of implant position 2) To prevent implant movement. The main advantage of this technique is the fact that the implants are precisely held in position.

Siamak Agha, MD, PhD
Orange County Plastic Surgeon

What is "subfascial" breast augmentation?

There is a reputable surgeon in my area who advocates subfascial implant placement for some cases. I respect him but have no real understanding of how this is different from a standard above the muscle implant. As Dr. Aldea said, the fascia of the pec muscle is nothing of any substance so there really can't be two disctintly different planes, one above the fascia and one below it. You'd almost always be better off going below the muscle for better mammograms, less capsular contracture,... more

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

This is a hoax

I do not believe that it is possible to place the implant under the fascia above the muscle. I have done thousands of implants -- that fascia is nothing. I have never seen nice thick fascia, thus I don't believe it is a real proceedure.

William B. Rosenblatt, MD
New York Plastic Surgeon

Experience with subfascial implant placement

There is a lot of confusion about the subfascial plane, and since I published the first study in north america on the technique several years ago I have quite a lot of experience with it. The procedure is fairly common in south america, and more coomon in Canada than the U.S., but it is slowly catching on. Here are the main things you need to know: The fascia is thin, but since it is left in continuity with the overlying breast tissue and not raised up as a paper thin flap by itself, it... more

Richard Baxter, MD
Seattle Plastic Surgeon

Sub-fascial implants

Make it unanimous. This to me seems to be a solution in search of a problem. In addition to what my colleagues have said, you will not get muscle atrophy, as we typically don't cut the nerves to the muscle, there will be no "interference", and the pain will be similiar as you will still be traumatizing the muscle.

Scott E. Kasden, MD
Dallas Plastic Surgeon

Subfascial implants probably don't remain subfascial long-term

The pectoral fascia is so thin and flimsy, it amazes me that surgeons can reliably raise it as a discrete layer and place an implant beneath is without tearing the fascia or thinning is substantially. The risk of post-operative bleeding is also higher. A lot of sub-fascial implants become subglandular over the long-term. Its been well documented that breast implants last longer and perform better when they are placed in the submuscular position.

Scott Sattler, MD
Bellevue Plastic Surgeon

Sub-fascial vs. submuscular implants

I also do not feel there is much difference between subglandular and subfascial implants and that subfascial implants do not give any of the benefits of submuscular implants. The concerns you have about submuscular implants are relative and may not override all the pros with this type of placement. Pain is usually quite temporary and can be ameliorated by a number of means. Atrophy is not a significant issue if you use reasonable sized implants and you do not develop capsular contracture,... more

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Difference in sub-fascial breast augmentation

The focus of breast augmentation discussion has primarily been under the muscle, or over the muscle. The benefit of sub-muscular augmentation has been better cover of the implant over time, improved contour, and fewer breast capsule contractures. The positive impact has been so great that most breast augmentation is performed in the under the muscle position. Of course the under the gland or over the muscle augmentation has some advantages all its own, a better marriage between the breast... more

Peter E. Johnson, MD
Chicago Plastic Surgeon

www.peterejohnsonmd.com

Subfascial implant placement is not helpful in my opinion

The fascia is less than a millimeter thick. Why would placing the implant behind a diaphanous 1 mm sheet make any improvement or help in concealing implant irregularities. There is not enough fascia to adequately cover the implant. I am not sure even what it means to do a sub fascial implant.

Francisco Canales, MD
Santa Rosa Plastic Surgeon

Implant placement

This is not well studied and it is likely that you will lose all the benefits of placing the implant under the muscle. There is likely very little difference between subfascial and subglandular.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Subfascial Breast Augmentation

Although some surgeons CLAIM that placing an implant ABOVE the muscle but under its outside lining (fascia) is superior to placing it above the lining - the anatomical facts just do NOT support this claim. The Pectoralis Major muscle fascia is EXTREMELY flimsy and thin. Surgically, the fascia is the thickness of a Kleenex tissue and as such It does not provide a durable thick cover to the implant. In my opinion, the claims of the superiority of sub facial / Over the muscle breast... more