Implant Placement - thoughts on subfascial? (Photos)

Question

I don't know what to do. I am 37 and breastfed all 4 of my children for almost 9 years total. I am now 2 years out from that and my breasts are totally deflated. I am in great shape and workout 5+days a week. I feel like my nipple is in an okay place and I don't need a lift but my skin quality is not what it used to be. My boobs have grown and shrunk so many times. I love the idea of a subfascial placement but I also want the most runway from this procedure. Ideally I would like these to age well and I care more about that than how they look for the next 5 years. I am only interested in a smaller implant size, I'm thinking anywhere from 180-275ish. I am 5'10 and weigh about 128 pounds. Also with the subfascial I have very little tissue to hide the implant and it's not like my skin is getting any thicker. I don't love the idea of under the muscle because of how I workout but if there is an advantage to that long term I will do it. Just wondering what everyone thinks, a lot of younger surgeons are all about the sub facial but even with my skin quality? not sure. any suggestions advice would help.

Zoran Potparic, MD · Answer

Providing that you want a small volume implant I believe that subfascial placement would give you satisfactory result. Good luck.

Gary M. Horndeski, MD · Answer

Your breasts are in a good position on the chest wall and your nipple-areola complex is above the inframammary fold. For these reasons, you do not need a lift. I recommend small implants with a wide base. This will give you more medial implant placement. I recommend submuscular since you are so thin. In front of the muscle or subfascial will not effective because the fascial placement is so thin is does not produce any padding.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Joe Gryskiewicz, MD, FACS · Answer

You have done very, very well.  Great nipple placement.  If you are active then taking the muscle out of the equation to avoid window shading or animation deformities would trump a slightly deficient upper pole in my opinion.  I have been in practice for over 40 years and do mostly subfascial for many advantages.   Did about 300 last year.  The newer implants rarely wrinkle, but in your case, you want to be super sure to be UNDER the upper pole fascia.  And maybe leave a cuff of tissue inferiorly and a whisper of muscle on the outside to support the implant.  I like your choice of size.  You can ask around for a PS who practices the quick recovery approach.  I would do what you are doing.  I think you will look great.  Good luck.  Dr. Joe Gryskiewicz

Brian K. Reedy, MD · Answer

Thanks for your question! You are VERY thin in the upper pole. I think subfascial implants are an option, but you will have to accept looking at the seam of the implant a bit more than other patients. If you want the most natural look, dual plane is probably your best answer. An in person consultation would be the best way for you to get an accurate evaluation. Best of luck!

Camille Cash, MD · Answer

There is no right or wrong answer on where to place implants, but rather things to think about.  The advantages of placing the implants above the muscle are that it has a little easier recovery and may give a fuller look.  Placing implants beneath the muscle carries a lower risk of capsular contracture, gives a bit more of a natural look, gives some camouflage of the implant at the upper portion of the breast, and the muscle gives some support for the weight of the implant.  I encourage you to meet with a few board certified plastic surgeons near you to listen to various viewpoints.

Manuel Diaz, MD · Answer

Hello. Based on your photo and the goals you described, I would recommend silicone implants placed under the muscle. 
Since you have very little existing breast tissue and thin soft tissue coverage after breastfeeding, placing the implants under the muscle would provide better coverage, create a smoother upper pole, and reduce the visibility or rippling of the implant over time.
To answer your questions:
Submuscular placement is likely the better option in your case because of your limited breast tissue and skin quality.While subfascial placement can be an excellent option for some patients, I believe it may leave the implant more visible in someone with your anatomy.Based on your photo, I do not think you need a breast lift. Your nipples appear to be in a favorable position, and a small silicone implant in the 180–275 cc range should restore upper pole fullness while maintaining a natural appearance.Although you are very active, most patients are able to return to their exercise routine after an appropriate recovery period.
A personalized evaluation is the best way to determine the ideal implant size, profile, and placement for your anatomy and desired result.

Implant Placement - thoughts on subfascial? (Photos)

Answers (6)

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