Does textured or silicone make a difference? Do you ever need to do revisions on those? If so, why? Are there any patient complaints unique to this technique? Does a capsule form with a placement in this area? Have you done any replacements for these implants and is it more difficult than with another placement? What kind of follow-up do you have with this? Length of time? Patient satisfaction remains high? If the fascia were to tear, how would the repair be done?
Answer: Does subfascial #breastaugmentation reduce the risk of #capsularcontracture? 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...
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Answer: Does subfascial #breastaugmentation reduce the risk of #capsularcontracture? 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...
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