What Are the Advantages and Disadvantages of Subfacial and Submuscular Placement? (photo)

Subfascial augmentation is a very misunderstood procedure.  Those that are inexperienced or ignorant say it is a farse or the same as subglandular, but this is the farthest thing from the truth.  Subfascial is the only technique that can provide true shaping support from within the breast and maintain a dissociation from the pectoralis major muscle minimizing implant movement of 'animation.'

 

I find the fascia so crucial in creating a beautiful breast shape that I developed something called the 'cold-subfascial augmentation' which preserves all of the fascia and allows precise shaping of a breast to fit the individual patient.  Dual plane implants are plagued by lateral displacement, bottoming out and muscle jumping or animation.  I hope this helps!

 

All the best,

 

Rian A. Maercks M.D.

It's a great question. I strongly prefer under the muscle implants because the muscle provides another layer of camouflage for your implants. The muscle contours the top of the implant to give it a more natural slope and hide rippling of the implant. Implants under the muscle have a decreased risk of scar tissue forming around the implant (capsular contracture).  Also, breast cancer screening with mammography gives better images of breast tissue when implants are placed under the muscle. Although an implant on top of the muscle can be a good choice for some women, for very thin women there is not enough camouflage for the implant to look natural. When considering breast augmentation make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options, so that you can decide if breast augmentation is right for you.

Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery andrecovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity

Hi there-

The superficial pectoral fascia under which implants are placed in the subfascial approach is so thin that over the long term there is little difference between this technique and subglandular placement. 

In other words, the average woman desiring breast augmentation is best off with sub-pectoral placement. Even when the immediate outcome of subglandular or subfascial augmentation is pleasing, it is not as long lasting, and inevitably deteriorates much faster due to the relative lack of support for the implant.

The most popular technique for breast augmentation in the U.S. at this time is submuscular placement of the implant.  The reason for this two fold.  The first being a much lower rate of capsular contracture (scar tissue tightening around the implant), and secondly, a more natural contour to the upper portion of the breast. Subfascial placement of the implant most often refers to implants that are placed behind the muscle in the upper portion of the breast and are not completely covered by the muscle in the lower portion of the breast. This may also be referred to as "dual-plane" technique.  Originally implants were placed in the sub-glandular plane (between the breast tissue and muscle fascia), however, this technique may result in more visibility of the edge of the implant and has a higher rate of capsular contracture.  Some surgeons attempt to place the implant totally under the muscle fascia ( a thin layer of connective tissue on the surface of the muscle), however, this technique may only reduce contracture rates, but not improve the contour of the breast as much as the submuscular approach. The main disadvantage of sub muscular placement is implant movement with muscle contraction (animation) which might be disturbing to some people.