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Subfacial Placement Vs Under/Over Muscle

asked 1 year ago by Essington7278
Latest answer by Thomas Fiala, MD
Question viewed 1,226 times
Tags: sagging, options, results, rippling

The surgeon I am considering does a subfacial placement rather than over or under the muscle. I can't find reports on subfacial augs. This doctor says because it takes longer and is harder to do. My concerns are rippling, sagging and my age. I had 2 other consults, one doctor told me I will sag terrible in 5 years and another said me my breast tissue was the most elastic tissue of my body and would have an amazing result. Opinions on subfacial and who to trust. Can I have a pretty breast at 55

18 answers to Subfacial Placement Vs Under/Over Muscle

Subfascial breast augmentation

The sub-fascial approach has been presented at the Plastic Surgery meetings over the last few years. To me, it's hard to understand how effective a very thin (less than 1 mm) layer of collagen - the muscle fascia - is going to make a difference compared to subglandular placement of the implant. The science behind the subfascial technique, proving some long-term advantages, is just not there yet. As such, I would not recommend it to you (or anyone else) at this time... more

Thomas Fiala, MD
Altamonte Springs Plastic Surgeon

Subfascial Breast Augmentation

Pretty breasts at age 55: Absolutely! Your question was about subfascial versus submuscular augmentation. Subfascial augmentation is performed between the lining of the pectoralis major and the muscle. Submuscular augmentation is under the pectoralis major muscle. Both are great approaches. In order to be a candidate for the subfascial approach, you must have at least 2 cm of subcutaneous tissue to cover the implant. Also, your request for implant... more

Jennifer Buck, MD
Tampa Plastic Surgeon

Subfascial - really a subglandular plane - avoid it!

The pectoralis muscle is covered by a fascia, which is sort of fibrous sheet separating it from surrounding tissues. In the subfascial plane, the pectoralis muscle fascia is dissected off the underlying muscle and the implant can be placed in this plane. However , this plane is very thin and I do not think it makes any difference from suglandular plane. I have not performed suglandular/subfascial breast azugmentation in 10 years. Not because I cannot do it (it is simpler than under the... more

Gregory Turowski, MD, PhD
Chicago Plastic Surgeon

Breast implants over the muscle work very well.

Hi. Just going by your pictures, you look like an ideal candidate for moderate size, smooth walled, round, silicone gel breast implants placed over the muscle. This will correct your slight sagging best. And implants will not make sagging worse. see video

George J. Beraka, MD
Manhattan Plastic Surgeon

Subfascial versus subpectoral breast implant placement

I advise my patients to avoid all experimental procedures. As such, the subfascial technique is a new technique that hasn't been thoroughly evaluated. If this layer is thin, then it may not even provide much support to your implants. Additionally, this technique may not provide the benefits of submuscular implant placement which allows the pectoralis muscle to message your implants continuously and help avoid capsular contracture. I would recommend you get a couple more opinions prior to... more

Arian Mowlavi, MD
Laguna Beach Plastic Surgeon

Breast Augmentation, Breast Enlargement, Breast Implants

Breast augmentation is an option for you. You have many different choices when it comes to the augmentation. The implants can be placed under the muscle or in the sub-facial location. The implants can be placed in the sub glandular position also but this is done less frequently. IT is more difficult to place the implants in the sub facial location. If the surgeon has a lot of experience with this technique you will be fine. You can expect to have good... more

Jay H. Ross, MD
Tampa Plastic Surgeon

Subfascial approach better than simply above the muscle

Dear lady, the subfascial approach simply means that the implant is placed just underneath the membrane which exists around the chest muscle. The advantage is that it gives more influence of the implant on the breast shape (correction of the drooping) because more superficially located, but has less chance of being visible or palpable at the edges. In combination with a type of implants which is well attached to its pocket, such as polyurethane-covered implants, this gives a very... more

Alexis Verpaele, MD
Belgium Plastic Surgeon

Subglandular vs. Subfascial vs. Submuscular Breast Augmentation

As you can see, this is a highly debated question amongst experienced surgeons with each option having been recommended. This debate is contested in our meetings and only in the past 5-10 years has the subfascial implant position been added to the discussions. The fascial layer is of variable thickness in patients, but generally quite thin which makes its dissection fruitless at times; however, it has its proponents. For two reasons, I would recommend a... more

Luis Zapiach, MD
Paramus Plastic Surgeon

www.artplasticsurgeons.com

Breast Augmentation

Based on your pictures, you look like a good candidate for breast augmentation. However, a in-person consultation / examination would be required. If you are happy with the doctor and the results that you see in other patients, then go for it. Don't try to make the surgeon do the surgery a different way than what they usually do. If you do not want the sub-facial procedure then seek out a board certified plastic surgeon that does submuscular implants. In my... more

David Shafer, MD
New York Plastic Surgeon

Can I have a pretty breast at 55?

Absolutely you can have BEAUTIFUL breasts at 55! Your breasts are actually quite nice, and will look great with implants. I disagree that in 10 years you will have alot of sagging- depends on what technique you have. If you have implants placed behind the muscle, you will have a good support mechanism for the weight of your implants, and a fuller, more youthful breast. If you have sub-fascia or sub-glandular placement, you will still have a nice look (if you get... more

Amy T. Bandy, DO
Newport Beach Plastic Surgeon

Where to insert breast implants: behind or in front of the muscle?

There are many advantages of placing the implants behind the muscle and very few for above. You should be able to have a very nice outcome with properly sized implants placed in a submuscular pocket. Good luck!

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon

Subfascial implants

To me subfascial does not make sense. Either place them under the muscle or sublgandular, I prefer submuscular( dual plane) for most patients. This provides betters soft tissue coverage in the superior pole.

Steven Wallach, MD
Manhattan Plastic Surgeon

Sub-fascial breast augmentation - marketing gimmick

The fascial overlying the pectoral muscles is thin. The plane between the fascia and muscle is vascular and bloody. Placing an implant subfascially does not make a lot of sense. I can understand why subglandular placement of an implant might be important to some patients. I just don't see why placing an implant behind a thin veil of fascia offers any advantage. Perhaps one of the surgeons on this forum can explain it to me. My advice is to keep a simple operation simple - place the... more

Scott Sattler, MD
Bellevue Plastic Surgeon

References for subfascial breast augmentation

The use of the subfascial plane is common in Europe and South America but for some reason slow to catch on in the U.S. The fascia (rhymes with fashion) is thin but sturdy enough to add support. There aren't a lot of consumer-oriented resources but here are two scientific articles: Baxter R. Subfascial Breast Augmentation: Theme and Variations. Aesthetic Surgery Journal 25(5);447-53, 2005. Hunstad JP, Webb LS. Subfascial Breast Augmentation: A Comprehensive Expreience. Aesthetic... more

Richard Baxter, MD
Seattle Plastic Surgeon

Subfacial implant vs under the muscle

Subfacial implant placement makes no sense whatsoever. The fascia is so thin it offers no camouflage (the main reason for sub-muscular placement). Going on top of the muscle can accelerate sagging so dual plane placement under the muscle is likely best for you. Good luck!!!

Marcel Daniels, MD
Long Beach Plastic Surgeon

Subfascial breast augmentation

The concept of subfascial breast augmentation is an illusion to many surgeons and was coined to bridge between under and over the muscle breast augmentation. The debate concerning under the muscle or over rages on though most, perhaps 80%, of implants are placed under the muscle to hide the upper potion of the implant, reduce ripples, and to reduce capsular contracture. These advantages are very real. Some will do better with an implant over the muscle for reasons you can explore on this... more

Peter E. Johnson, MD
Chicago Plastic Surgeon

www.peterejohnsonmd.com

Yes you can!

It seems from the photos that you are a great candidate for breast augmentation. You have minimal sagging ( I would need to look at your breast profile as well). What you could benefit from is an implant that will give you volume in the upper part of your breast without being extremely large to weigh your breast down. In my opinion from the photos, a subglandular / subpectoral gel implant would be a suitable choice for you. Good luck !

Dana Khuthaila, MD
New York Plastic Surgeon

Breast Augmentation Questions

You can absolutely have a pretty breast at age 55! Breast implants can be placed under the muscle or over the muscle. Implants placed over the muscle are either under the breast tissue or under the breast tissue and muscle fascia. The muscle fascia is a very thin layer of tissue, as thin as a piece of paper. Looking at your photos, I would recommended implant placement under the muscle.