Subfascial or submuscular in my case?

Question

29 F. 34B, 135 lbs. I was told I have a wide chest (or wide breast bone?) and a mild tuberous deformity in one of my breasts. Also my breasts sit kind of low. I want them to look very natural and about 1-2 cup sizes bigger. One doctor told me a moderate profile responsive implant placed submuscular would be most natural and another said low profile SoftTouch placed subfascially would be most natural. Any advice?

Chet Mays, MD · Answer

Thank you for your inquiry!  We would love to sit down with you to discuss your concerns.  Schedule a consultation with a Board-Certified Plastic Surgeon to help you reach your goals!

Ellen Ozolins, MD · Answer

Thank you for your question. Your body type influences the breast implant's location, the intended result, and your breast tissue. Both subfascial and submuscular implantation benefit a low breast with a broad chest and minor tuberous deformity. Submuscular implantation is often advised for patients who are thin or have less breast tissue. It can provide the breast implant greater coverage and fullness, which is advantageous in difficult instances such as tuberous breasts. The subfascial placement has reduced postoperative discomfort and provided support to reduce implant edge visibility and palpability. Also, to increase 1-2 cup sizes, you would look for implants ranging from 150 to 200 CCs for each cup size increase. But depending on your physique and the amount of breast tissue you currently have, the volume required may change. A thorough consultation with a board-certified surgeon is necessary to decide on the best implant type, size, and pocket location. They will consider your breast's base width, the distance between your nipple and fold, the thickness of the skin pinch, and other dimensional factors.

Gregory Lakin, MD · Answer

Thank you for your question. Your body type influences the breast implant's location, the intended result, and your breast tissue. Both subfascial and submuscular implantation benefit a low breast with a broad chest and minor tuberous deformity. Submuscular implantation is often advised for patients who are thin or have less breast tissue. It can provide the breast implant greater coverage and fullness, which is advantageous in difficult instances such as tuberous breasts. The subfascial placement has reduced postoperative discomfort and provided support to reduce implant edge visibility and palpability. Also, to increase 1-2 cup sizes, you would look for implants ranging from 150 to 200 CCs for each cup size increase. But depending on your physique and the amount of breast tissue you currently have, the volume required may change. A thorough consultation with a board-certified surgeon is necessary to decide on the best implant type, size, and pocket location. They will consider your breast's base width, the distance between your nipple and fold, the thickness of the skin pinch, and other dimensional factors.

Daniel Barrett, MD · Answer

Dear hdk9920,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Tyler Frew, MD · Answer

Hi there,
I think both options could get you to the look you are after, but there are some things to consider.
For the subfascial to work well and not be visible (rippling) your skin and breast have to be thick enough to camouflage the implant, which is typically around 1.5-2cm of thickness by pinch. Subfasical can typically make you cleavage closer together than submuscular as the pocket can be created as close to the midline as needed whereas the submuscular pocket is always stopped medially by the actual muscle attaching to the sternum. 
Your MD may also be recommending subfascial due to your tuberous breast. By putting the implant right below your breast tissues, the tissues will more readily mold to the implant shape and correct the tuberous shape.
Submuscular has a very low incidence of rippling and the muscle acts as extra padding for the implant, therefore making it look more natural. It can also correct the tuberous shape. 
I would recommend you ask both MDs for photos of tuberous breast correction they have done as both ways could work for you
All the best

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon' s experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Andrew T. Cohen, MD, FACS · Answer

Hard to answer your question without a picture.  Descriptions don't work on this forum. 
 Not a fan of anything "low profile"    That has never worked for me. 
 I like a smooth round full profile under the muscle.  Allergan SSF ( smooth soft touch full profile) is my favorite.   Under the muscle...submuscular is the way to go.   Subfascial is interesting but just another way to basically stay above the muscle .  I feel under the muscle protects the implant and looks natural and less chance of encapsulation.   Best to see a board certified plastic surgeon who does a ton of implants and revisions. 
Good luck!

Andrew Cohen, MD

William Aiello, MD · Answer

Firstly, it's essential to understand that both may have valid perspectives, but the ultimate decision should be based on your specific anatomical features, personal preferences, and the recommendations of a board-certified plastic surgeon whom you trust.

Regarding the options presented:

Moderate Profile Responsive Implant Placed Submuscular:
Moderate profile implants tend to have a slightly more projecting shape compared to low-profile implants, which can provide a natural-looking enhancement.
Placing the implant submuscularly (beneath the chest muscle) can offer more coverage and a smoother transition, especially for individuals with thin tissue coverage or a wide chest.
This option may be suitable for achieving a natural-looking result while providing sufficient support and coverage for your wide chest and mild tuberous deformity.

Low Profile SoftTouch Implant Placed Subfascially:
Low-profile implants have less projection from the chest wall, which might be beneficial if you're aiming for a subtle enhancement.
Placing the implant subfascially (between the chest muscle and the fascia covering it) can provide a more natural slope and movement, especially for those with adequate tissue coverage.
This option may be suitable if you prefer a more subtle augmentation and if your anatomy allows for adequate coverage and support with a subfascial placement.
Consider the following factors when making your decision:

Anatomical Considerations: Your wide chest and tuberous deformity will influence which option is most suitable for achieving a natural-looking result. Ensure the chosen approach addresses these concerns effectively.
Desired Outcome: Clarify with your surgeon what your expectations are regarding size, shape, and overall appearance. This will help them recommend the most appropriate implant type and placement technique.
Long-Term Considerations: Discuss the longevity and potential risks associated with each option, including future revisions or complications that may arise.
Surgeon's Expertise: Choose a board-certified plastic surgeon with extensive experience in breast augmentation and a track record of achieving natural-looking results. Their expertise and understanding of your unique anatomy will greatly influence the outcome.
It's essential to have thorough consultations with both surgeons, asking any questions you may have and ensuring you fully understand the proposed procedures and their implications. Additionally, consider seeking a second opinion if you're uncertain or want further reassurance before making your decision.

Camille Cash, MD · Answer

Without photos or an exam it's difficult to give specific recommendations.  Breast augmentation and implant selection options are best decided in person with an experienced board certified plastic surgeon.  Each candidate is unique and has specific goals for their "wish" look.  If you are unsure about the advice you received you may wish to meet with a couple other board certified plastic surgeons for their opinions.

Connie Hiers, MD, FACS · Answer

You did not post photos which would have been very helpful. However, I suggest the submuscular placement to give more upper breast fullness and hide the implant edge.

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