For anyone who does subfascial breast implants: do you notice a lower rate of capsular contracture issues?

Hello,The scattered few surgeons that are proponents of subfascial surgery have yet to prove that it is any different than subglandular surgery anatomically. What most of us contend is that the fascia is whispy thin and fragile; actually elevating it without holes or keeping it intact while placing the implant is impossible. There is no data on capsular contracture rates, but likely the same as subglandular placement and higher than dual plane subpectoral placement. Further, it offers no soft tissue buffer from the implant, leaving the patient at high risk for palpability and rippling. The use of texture implants reduces the risk of not only capsular contracture, but also implant malposition, however highly cohesive implants should be chosen with textured shells to avoid rippling. Go visit a few ABPS certified/ASAPS member surgeons who specialize in breast augmentation. You'll find 99% would recommend subpectoral placement. Best of luck!

There are multiple studies showing a higher capsular contracture rate in the subfascial and subglandular placement of breast implants. It has been shown that textured implants in the subfascial or subglandular position decrease this risk. Yet, the lowest rate of capsular contracture is with smooth implants under the muscle. I no longer recommend textured implants due to their relationship with increased risk for cancer: anaplastic large cell lymphoma, ALCL. The risk is low, between 1 in 3,000 and 1 in 10,000, but I prefer not to risk it.#StayBeautiful #RealDrWorldWide 

I recommend sub muscular (dual plane) placement with round smooth saline or silicone (non-textured) implants. I have had only 4 capsular contractures in 13,000 breasts.Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

There are a few plastic surgeons (some are my good friends) who advocate for and perform "subfascial" breast augmentation routinely. In my experience doing both cosmetic and reconstructive breast surgery, the pectoralis fascia is often thin and hard to elevate off the muscle while keeping it intact as a layer. I'm not sure, as another surgeon has aptly discussed, that this just isn't a subglandular breast augmentation under another name. I do agree that ideally, a subfascial approach, if the fascia is robust enough and supportive of the implant, seems to be more "anatomic" a technique, since the implant is placed close to where the breast tissue is. In patients with large breast volume preop, a subglandular/subfascial approach may be reasonable, especially in those who need a small lift and don't want one (the other alternative being anatomic implants in many of those patients).  However, since we have extensive literature describing lower capsular contracture rates when at least some of the implant (typically the upper 60% or more) is covered by the muscle, the standard of care is usually subpectoral/dual plane placement in most communities. I have not seen a well-designed, large study of breast augmentation patients comparing subfascial to dual plane vs. subglandular to draw enough of a distinction. Replacement of "subfascial" implants with capsular contractufre is basically the same as replacement for capsular contracture with subglandular implants: lift the muscle, move new implants to that pocket, and seal the old space. Hope this helps...