Are round or anatomical implants best for subfascial placement?

After researching quite a bit I'm almost positive it would be best for me to choose a subfascial placement. However, has it been established in literature (or through your own experience), that anatomical or tear-drop shaped implants have the same risk of rotation as in submuscular and subglandular placements? Or does the fascia decrease that risk, sort of like an internal bra? Thank you.

Doctor Answers 15

Are round or anatomical implants best for subfascial placement?

Thank you for the question. These days there are a variety of breast implants available; the variety of breast implant available raise a lot of questions from women considering breast augmentation surgery. Personally, I think that for most patients considering breast augmentation surgery, careful selection of plastic surgeon and careful communication of goals, far outweigh the specific type of breast implant utilized (when it comes to the success of the breast augmentation procedure).

Anatomical breast implants were designed to better simulate the natural breast shape; the problem with these implants is that if they shift or rotate, the entire breast will change shape as well. This change in breast shape may require further surgery to correct. Round implants, under the hand, can shift or rotate without changing the shape of the breasts. Overall, I find that beautiful outcomes can be achieved with the use of round saline or silicone gel breast implants for the vast majority of patients.

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “very natural” or "B or C cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Round or Anatomical Implants for Subfascial Placement

Your doctor will work with you to choose the best implant #shape and #implantprofile based on your goals and measurements.In my practice, about 15-20% of the patients are good candidates for silicone #shapedimplants.

The three main placements we use which are effective are #SubMuscular, SubGlandular, and #DualPlane. Each are beneficial according to implant type and placement. The possible benefits of #submuscular placement are that it may result in less palpable implants, decreased risk of capsular contracture, and easier to image the breast with a mammogram. Under the muscle placement is recommend for women are are very thin with very little breast tissue. The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.

The #subglandular #placement may make your surgery and recovery shorter and you will likely have less discomfort. This placement can provide a slight “lift.” #Subglandular placement can result in more palpable implants, increased risk of capsular contracture and more difficult imaging of the breast with mammogram. This placement is often recommended for those patients with mild breast sag, but do not want a breast lift (mastopexy) and for tubular breast deformity.

The #DualPlane placement method is a more current technique most often used when there is mild breast sag and the patient does not want a breast lift. The breast tissue and muscle are partially separated to allow the breast tissue to sit in a better position. Dual-plane can be discussed further during the consultation should breast sag be of concern.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

Anatomic implants

I generally will use moderate profile implants in my augmentations.there was a study done  a few years ago comparing anatomic implants to round.they did serial mammograms and after several months the tear drop or anatomic implants became round.I really don't think it makes a lot of difference.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 54 reviews

Sub-fascial breast augmentation for a round or anatomical implants

I am not a fan of subfascial breast implant placement.  There should be no difference in the risk of malposition whether shaped implants are placed beneath the breast, beneath the fascia or beneath the muscle.  Generally speaking  round implants are able to adjust and conform to the breast anatomy earlier and better than shaped implants.

Round vs anatomical breast implants

Great question, but not so great answer.
I'm afraid subfascial  placement does nothing to improve implant migration. And, in my experience, round textured silicone implants are more stable than any type of anatomical breast implants. I prefer to place implants entirely under the muscle, never choosing subfascial, dual plane, or sub glandular placement.

I hope this information helps you.
Best wishes,
Gary Horndeski M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.7 out of 5 stars 208 reviews

Subfascial implants

Thank you for your breast implant question.

  • The subfascial placement of the implant will not hold it in position any more than any other position,
  • The tear-drop implant should be textured to reduce the risk of rotation,
  • I am told that subglandular textured Sientra implants have a very low risk of rotation based on the data now gathered but they are not yet been published. 
  • My experience with subfascial placement is that it works like a subglandular placement but hurts like a sub-muscular one. I am not convinced of its advantages compared to the other positions. Best wishes.

Subafascial implants

I prefer submuscular breast implant placement and have not been a big fan of anatomic implants because of the rotation possiblity.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Implants in the subfascial plane

The type of implant in the subfascial plane should be determined by the type of appearance that you are trying to achieve. The rotation of anatomic implants is mostly a result of the implant pocket dissection and not necessarily the pocket location. 

I would argue that the subfascial plane is just a subglandular plane that is cleverly advertised to be something more than it really is.  You still might want to consider a submuscular or dual plane approach.

I would suggest discussing these things with a surgeon that you trust. Reading and doing research is great. But, there certainly are times when the amount of information (much of which is contradicting) can really confuse even the best of us. I would propose that you will have the best results if you choose a surgeon first, listen to his/her advice, and then decide together what is best for you. This is a better recipe than deciding on a treatment plan based on your individual research and then finding a surgeon that will execute such a plan. 

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 76 reviews

Anatomic implant location

In my opinion subfascial placement of an anatomic implant does not decreases risk of rotation. The best prevention of rotation is a precisely executed pocket whether it's subglandular, in a dual plane or subfascial

Are round or anatomical implants best for subfascial placement?

I prefer smooth round silicone gel implants in the sub-fascial position.
I find that smooth implants  have a more natural feel

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.9 out of 5 stars 12 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.