Subfascial Implant Placement Risks?

I assume you mean by unders to overs, you are talking about your breast implants in relationship to the pectoralis major muscle. The subfascial plane is immediately superficial to the muscle, but underneath the pectoralis fascia. Many clinicians feel that this added layer of support is beneficial in decreasing the chances of negative sequelae, such as rippling and implant malposition. The frequency of the postoperative problems you list has more to do with the experience of the surgeon... more

Your question is a very good one. The subfascial technique is something I have been doing for 6 years and more than 400 cases. It is still uncommon in the U.S. but widely used in South America, Canada, and other countries. The fascia is a thin but tough layer on the surface of the muscle, so it can be used for support of the implant but it isn't thick enough to add "padding". There are some variations that help with this while still correcting the distortion that occurs with... more

I agree with the previous surgeon's response. Although I am a huge proponent of subfascial placement of breast implants and taking extra steps to preserve this fascia in my 'cold-subfascial technique the surgeon is the most important piece of the puzzle. If the surgery is not executed well then it really doesnt matter what you call it. For example there are practitioners that use terms such as subfascial as a marketing ploy and either destroy the fascia with... more

Sub fascial implant placement is a position for breast implant placement that is being done by some surgeons around the country. I don't understand the interest in it. The fascia over the muscle is extremely tin and it doesn't offer any significant additional coverage than a subglandular placement. If you want more coverage a submuscular pocket is better. There are nor studies that I know of that reports on long term complications with this approach.

The Fascia can be a delicate structure which can be difficult to raise intact. Commonly, when we perform breast reconstruction surgery after a mastectomy, the facscia is destroyed and we need to reuild it. This is one of the most commonly performed breast reconstruction technique. However, we continue to place the implant under the muscle, but reconstruct the fascia over the lower half of the breast, where it is particularly thin. In augmentation patients, the fascia also becomes this over... more

Hi! Subfascial placement is a reasonable option for some patients. The problems you list can best be prevented (or corrected) by meticulous dissection of a well designed new implant pocket. Your particular anatomy would decide whether to use a subfascial or a subglandular (more common) approach. I don't think it is very important.

Dmchez, The risks that you mention are probably the same for almost all breast augmentation techniques and are very small. The submuscular plane seems to have a slightly lower incidence of capsular contracture. Symmastia and bottoming out are mostly surgical technique-dependent and not plane of placement. I would first ask why you are interested in changing your implant location? The submuscular plane is probably the most preferred by surgeons and patients alike. Developing a plane between... more

I have been doing breast implant surgery for over 30 years. In that time, I have put implants over the muscle, partially under the muscle, and completely under a muscle layer (only for breast reconstruction). The layer of fascia over the muscle is so thin and attenuated, that I have never seen or done a case where I could say it was sub-fascial. The fascia tears and fragments and you end up with an implant that is esentially over the muscle and under the breast. There is no difference in... more