How would subfascial augmentation look a couple of years after surgery?

You're right to think about how subfascial augmentation might look over time, especially given that the implants are placed over the muscle rather than under it. There are some important considerations when it comes to the long-term appearance and support of subfascial implants. Here’s what you can expect:

Long-Term Aesthetics of Subfascial Implants:
Support from the Fascia Layer: While the fascia provides some support for the implant, it is a thin layer of connective tissue and doesn’t offer as much strength as muscle. Over time, the natural aging process, along with the effects of gravity, could cause the implant to settle or droop, particularly if the skin becomes more lax.

Breast Tissue Changes: Your natural breast tissue will continue to age, just as it would with any breast augmentation. If you lose or gain weight, or if your skin loses elasticity, these changes could impact the overall look of the implant over time. Since subfascial implants rely on your skin and breast tissue for support (as opposed to muscle), this placement may result in more visible changes as time passes compared to submuscular placement.

Potential for Sagging (Ptosis): Since the implant is placed over the muscle, there may be less structural support, and sagging could potentially occur over the years, particularly if your skin loses elasticity or if you have thin breast tissue to begin with. The fascia provides some lift, but it's not as robust as the muscle beneath it. This could result in the breasts appearing more drooped or "bottomed out" over time, depending on your anatomy and skin quality.

Implant Visibility and Palpability: In the subfascial plane, especially if you have thin breast tissue, the implant may be more visible or palpable, meaning you could feel the edges of the implant more easily. Over time, as your skin thins or stretches, this effect could become more noticeable.

Changes in Breast Shape Due to Exercise: Since the implants are placed over the muscle, they won’t be affected by muscle movement during exercise, which is one of the reasons this placement is recommended for people who lift weights frequently (like yourself). Over time, the implant's position will remain unaffected by chest muscle contractions, unlike with submuscular implants, which can sometimes shift when the pectoral muscles are engaged.

Factors That Influence Long-Term Results:
Implant Size and Weight: Larger implants put more strain on the skin and tissues, which can lead to sagging over time. If you opt for a moderate-sized implant, this will put less pressure on the skin and decrease the risk of sagging or "bottoming out."

Skin Elasticity: The elasticity of your skin plays a major role in how well your breasts will maintain their shape. If your skin is naturally more elastic, it will be able to support the implant better over time. However, if your skin is thinner or has lost elasticity (due to aging or weight loss), the implant might not stay as perky, and sagging could occur sooner.

Age and Lifestyle: As you age, the skin naturally becomes less elastic, and this can lead to sagging. Additionally, factors like sun exposure, smoking, and weight fluctuations can accelerate the loss of skin elasticity, impacting how well your breasts hold up over time with subfascial placement.

Can You Maintain Longevity with Subfascial Implants?
While there is some risk of sagging due to the lack of muscle support, many women with subfascial implants maintain good results for years, especially with the right care. Some factors to consider for long-term success include:

Choosing the Right Implant Size: Opting for an implant size that fits your body and doesn’t put too much strain on your skin is key. Larger implants may accelerate sagging, so a smaller, more moderate implant can help prevent this.

Supporting Your Skin: Taking care of your skin with moisturizing, avoiding significant weight fluctuations, and wearing a supportive bra, especially during exercise, can help prolong the appearance of your implants.

Considering Future Lifts: It’s possible that over time, you may need a breast lift (mastopexy) to maintain the perky, youthful look you want, especially if sagging becomes a concern after several years. A lift can correct ptosis and reposition the nipple and breast tissue while keeping your implants in place.

Summary:
Subfascial breast augmentation can look great, especially in the early years, but the longevity of the results depends heavily on your skin quality, implant size, and natural aging processes. Since the implants are placed over the muscle, the support mainly comes from your skin, tissue, and the fascia layer. Over time, as skin elasticity decreases, there may be a higher chance of sagging compared to submuscular placement.

If maintaining a long-term perky look is your goal, opting for moderate-sized implants, taking care of your skin, and perhaps considering a lift down the road are ways to manage this. Regular check-ups with your surgeon can also help monitor how your implants are holding up over time.

Hello,
A subfascial breast augmentation should look similar to how you are post op to a couple years post op. Given that the pectoral muscle isn't pushing on the implant over time like a submuscular breast augmentation, there is less risk for malposition.
All the best,
Dr. Joe