Can You Switch from Subfascial to Sub Muscular?

What does it take to switch from subfascial to submuscular? Is it risky or hard to seal off the pocket to prevent the implant from slipping back to the Subfascial pocket? How will you seal off a Subfascial pocket? I am Subfascial now and I have developed a second CC on one side. The other side is fine. I am hoping going under will eliminate the CC. Although I take a risk by messing with the one that is fine. I'm my first capsulectomy doc removed it and cleaned out pocket and replaced same implant

Doctor Answers 8

From Subfascial to Submuscular Breast Augmentation

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Dear FitDiva,  Converting from a subfascial pocket to a submuscular pocket is not a difficult procedure for an experienced plastic surgeon.  Keys are to close the subfascial pocket so that the implant cannot flip out of the submuscular pocket and back into the subfascial pocket.  This is usually done with a series of sutures.  If a patient has a capsular contracture, it is not recommended that the same implant be re-used.  Though there is no clear proof of what causes a capsular contracture to occur, a large amount of data suggests low levels of bacterial contamination and biofilm growth.  This cannot be removed by simple washing of the implant.  A new implant is required.  There are some recent studies that show improved results in treating capsular contractures using materials such as Strattice but these are early studies and the Strattice material is costly.  These are things to discuss with your plastic surgeon.  Hope this helps.

Saint Louis Plastic Surgeon
4.7 out of 5 stars 87 reviews

Subfascial to submuscular for capsular contracture

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The operation to go from the subfascial plane to the submuscular plane is not technically difficult. The original space can be closed with stitches. Keep in mind that the muscle will only cover the top part of the breast, not the sides or bottom. There is also the chance on animation deformity. Another option for capsular contracture is the use of Strattice.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 56 reviews

Converting Sub glandular to Sub muscular Breast Implant Positioning?

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Thank you for the question. Closing off the space currently surrounding your breast implant is not a difficult procedure;  this is commonly done with the use of sutures.  Given your history, it sounds like your plan to convert to the sub muscular breast implant position may be an excellent one.

 Make sure your plastic surgeon has significant experience performing revisionary breast surgery.  You may find the attached link helpful to you as you learn more.

Best wishes.

Pocket Conversion

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Switching the plane of implants from subglandular to submuscular requires some work.  When performing a pocket conversion augmentation, we normally recommend placing the implant under the muscle and closing the pocket with a biologic.  The biologic is used as a sling to create a support and a barrier for the implants.  The biologic wall stops the implant from moving from the submuscular plane.

M. Mark Mofid, MD
La Jolla Plastic Surgeon

Can You Switch from Subfascial to Sub Muscular?

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         Changing the implant to a submuscular plane is not a really challenging procedure and sealing the pocket is done with sutures.  A new implant should be placed during the procedure.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Subfascial to Subpectoral

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If you have had a capsulectomy for capsular contracture after subfascial breast augmentation, then your implant is NOT subfascial anymore, it is subglandular, and always at higher risk for recurrent capsular contracture. 

Switching from over to under is a common surgery and is usually not problematic.  The issue you are referring to involves the inframammary region where the subpectoral pocket can become one with the old subglandular/subfascial pocket.  Most of the time, I can keep a thin veil of tissue separating the two.  When that is impossible, then the pectoralis muscle needs to be sewn to the the lower wall of the old pocket, closing off the old pocket, and preventing it from 'window shading'. 

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 97 reviews

Can You Switch from Subfascial to Sub Muscular?

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Hi! Thank you for your question,

I am Dr. Speron, a proud member of both the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS).  I am also certified with the American Board of Plastic Surgery.

Switching from subfascial to submuscular can definitely be done by your plastic surgeon, and is not usually a difficult procedure at all. I highly recommend you schedule a follow up appointment with your plastic surgeon to discuss further options.

Below are some links for additional information and before and after pictures.

If you have any further questions, please feel free to call us at 847.696.9900.

Best of luck and have a great day!


Dr. Speron

Sam Speron, MD
Chicago Plastic Surgeon

Can You Switch from Subfascial to Sub Muscular

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It is not at all difficult to switch plane from subfascial to submuscular. The old pocket can be sutured if the complete capsulectomy is not needed. Some surgeons would recommend changing implants, though there is no clear consensus.  All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.