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

Question

How would subfascial augmentation look a couple years after surgery? I’m wondering that since it’s over the muscle, if it wouldn’t have as much support

Morad Askari, MD, MBA · Answer

Thank you for your question. Subfascial placement of implants will provide moderate support that maintains their position early, but like any implant placement, there will be a settling phase. Over the first year, implants may drop slightly as the skin stretches to accommodate them, and over time, the natural aging process with the effects of gravity may lead to additional sagging. So, subfascial implants may lose upper pole fullness over time as the implants settle and the skin stretches. This can result in a more natural slope but may not maintain the high projection some patients prefer. Also, you should know that if the pocket is not well-defined during surgery or the fascia stretches, implants may shift towards the sides or downwards, leading to asymmetry in contour. You can discuss these factors with your surgeon to help decide whether subfascial placement is best for your needs.

Ellen Ozolins, MD · Answer

Thank you for your question. After subfascial augmentation, many patients experience natural-looking results. However, over time, the fascia alone may not provide as much support as the muscle, particularly if you have thinner breast tissue or skin laxity. The lack of additional muscular support can lead to gradual implant descent, where the implant moves lower on the chest, causing the upper pole of the breast to lose fullness. The natural aging process, the effects of gravity, weight fluctuations, or loss of skin elasticity, could cause the implant to settle or droop. Also, if you have thin breast tissue, the implant may be more visible or palpable, meaning you could feel or see the edges of the implant more easily. If you’re concerned about the long-term effects, especially the risk of sagging, you might consider submuscular placement for added support. Discussing these options with your surgeon will help you decide which technique will provide the best long-term result for your unique body and goals.

Gary Lawton, MD, FACS · Answer

There is no place for subfascial implant placement.  Dual plane sub muscular implants offer the best outcome.

James M. Economides, MD, FACS · Answer

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.

Joe Gryskiewicz, MD, FACS · Answer

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

Irena Karanetz, MD · Answer

Hello,
 
Thank you for the question.
 
Both subfascial (above the muscle) and submuscular (below the muscle) breast augmentation will give you a fuller cleavage that you desire and nice long-term results.  However, not everyone is a candidate for above the muscle breast (subfascial) implant placement because if the breast tissue are very thin, implant rippling may be more pronounced in the upper pole of the breast and implants may bottom out more than submuscular breast augmentation.
 
In addition, placing the implants above the muscle (subglandular or subfascial plane) can help minimize animation deformity (when implants move during weightlifting).  
 
Implant size discussion and implant selection is one of the most important steps during your consultation with plastic surgeon. The decision-making process depends on patient’s desires, as well as breast and soft tissue dimensions.
 
I would encourage you to seek a consultation with a Board-Certified Plastic Surgeon to further discuss your options, specific techniques, concerns and expectations.
 
I hope this helps.
Best regards, Dr. Karanetz
 
Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon
Evolve Plastic Surgery
Queens, New York

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. I have been in practice almost 30 years and revisionary breast surgery is a large portion of my practice.  Subfascial is basically the same as subglandular.  The fascia of the pectoralis major muscle is a thin as tissue paper and provides almost no strength.  I have a whole gallery of chronic changes associated with subglandular breast augmentation.  Basically, after a few years the implant slides down the chest wall.  It is a rare occurrence for me to see a long-term aesthetically good outcome after subglandular breast augmentation.  Best wishes to you.

Camille Cash, MD · Answer

This answer will vary by patient.  It is true that subglandular implants don't have as much support as those under the muscle.  Patients who have poor skin elasticity or those who select large implants (or both!) will likely experience sagging more quickly than those who choose differently.  This is why it is important to take time when selecting your board certified plastic surgeon.  Look for someone who has many before/after photos for you to review and one who really listens to your concerns and goals for surgery.

Mats Hagstrom, MD (license on probation) · Answer

Plastic surgery outcomes are usually based on patient candidacy combined with the skill of the provider.
When it comes to breast augmentation, then implant selection is also of vital importance. 
The procedure has a fairly high revision rate with estimates that average The procedure has a fairly high revision rate with estimates that average revisions revision rates within the first five years is about 20%.
There are a few things both patients and surgeons can do to minimize the chance of needing revision surgery.
In regards to implant placement being above or below the pectoralis muscle, I personally have a fairly strong bias towards placing the implant under the muscle.
A lot of this has to do with how I was trained, but it is also the preferred approach by most Plastic surgeons who have a strong emphasis on breast augmentation in their practice.
I think the majority of plastic surgeons in the United States lean towards putting in plants under the muscle as being a better procedure.
Long-term results are based on what the patient’s tissues are like, the implant size used and the quality of the procedure.
Conditions like implants, bottom out or developing capsular contractions are potentially avoidable by using good surgical technique and selecting implants that are not excessively large.
Patients who are prone to developing breast “ptosis” or breast droopiness May need a lift after the augmentation.
This should be fairly predictable during a consultation.
If everything is done right and decisions are made well, and the patient has good candidacy then the results should look spectacular for decades.
If any of the above variables are off, then the patient may be dissatisfied with the results and revision surgery becomes necessary.
Best,
Mats Hagstrom MD

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

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