Looking for Doctors That Do Subfascial Breast Implant Placement?

Looking for a doctor that does subfascial placement. Preferably in the california area but i'm open to travel where ever. I heard it cost a bit more so please explain to me the price and procedure in detail. I've done my research on it and feel that this would be the best option for me and my athletic lifestyle. I want Cohesive gel sillicone aka "gummy bears" 375cc i'm about 34 b right now and i'm looking to achieve a full c/ small d. Thx so much :)

Doctor Answers 8

Subfascial breast augmentation with tear-drop shaped natural appearing breasts- its all in the details

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Subfascial breast augmentation is a very misunderstood technique.  I perform exclusively subfascial breast augmentation in my practice because I believe it is superior to any other technique in achieving a beautiful and naturally appearing breast.  Surgeons that perform subfacial augmentation are rare, and those that actualluy perform a true subfacial dissection are even more scarce.  As a small amount of interest has been developing in this procedure, there are some that will jump on subfascial augmentation as a marketing technique when they are really performing subglandular augmentation.  This is why I developed and am publishing a novel technique called 'cold-subfascial augmentation.'  


In reviewing results of those that claim to perform subfascial augmentation, there is a great variability in results.  I believe this is largely dueto the technique of disssection.  Most surgeons use electrocautery to burn the tissue during the dissection and assure a dry field.  While the extremely talented developer of subfascial augmentation and one of my mentors in training, Dr. Ruth Graf, uses electrocautery she always is careful to veer into the muscle to preserve the fascia.  The pectoral fascia is very thin and easy to damage such that a hot electrocautery device directly on the fascia can completely destroy it during dissection.  If the fascia is destroyed then the result is a subglandular placement and early negative changes can be expected.

I created the technique 'cold-subfascial augmentation' to protect the pectoral fascia in its entirety.  No electrocautery is used and the complete dissection is performed sharply with cold steel under direct visualization.  Thus there is not thermal or mechanical damage or stress to the fascia and a glistening white strong structure is left to hold and shape the implant like a bra inside the breast.  It is my preference to perform this procedure through a transaxillary incision so that there are no scars on the breast.  I also prefer to use low fill implants of cohesive silicone to allow me to shape a truley tear-drop shaped breast that appears natural and beautiful.  The advantages of subfascial augmentation performed well include natural spacing of the breasts ( unlike the widely spaced augmentation common with dual plane or submuscular techniques), little to no muscular animation(muscle jumping), Superior pole fullness with smooth transitions at the implant edges and long term structural support to protect against descent and aging.


Be careful to ask your surgeon how they perform the surgery and why they believe the fascia is important.  these questions may help you determine which one is right for you.  Also evaluate the pictures that they believe are good results, this helps determine if your aesthetic goals are aligned.  I hope this helps!


All the best,


Rian A. Maercks M.D.

Subfascial Augmentation

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The subfascial augmentation is only an advance for those surgeons who previously performed sub glandular without bothering to lift the fascia off the muscle - frequently these were surgeons who performed this operation using what is called blunt dissection. Most surgeons like myself who have always done our sub glandular augmentations under direct vision and using electrocautery to carefully elevate the breast tissue off the muscle have done it in the subfascial plane all along. In 18 years, I have never done sub glandular augmentation any other way. Doing it this way keeps a little more tissue over the implant, but don't be misled, it is still a sub glandular augmentation. The implants generally available in the US today are moderately cohesive, though not the true 'gummy bear' implants which are firmer and less mobile. Everything has advantages and disadvantages - if your tissue are thick enough, you may be an excellent candidate for subfascial (sub glandular augmentation) and if you have very strong pectorals muscles, doing a lot of upper body exercise, then this may be the best approach for you. However if you are very slim, with thin tissues in the breast area, think carefully before choosing a subfascial approach. In my practice we perform all methods of breast augmentation, based on the approach that best suits the patient's needs.

Subfascial breast implant placement, does it make a difference?

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The pre-pectoral fascia is an extremely flimsy structure that separates the pectoralis major muscle from the breast tissue. It is very easy to do the dissection under the fascia and when a sub glandular dissection is done inadvertently part of it is done under the fascia. I am not convinced that it makes any difference if you are below or above this insignificant structure. I think at this point it is primarily a marketing word. The good news for you is that if you were my patient and you were a good candidate for a sub glandular augmentation, asking me to do a subfascial placement for you. I would do it to please you knowing that it doesn't make a difference, therefore you would not be harmed by it.

Subfascial Breast Augmentation

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Hello Polegurl,

If you have your heart set on this technique, nobody is going to stop you.  However, regardless of claims being made about subfascial placement of an implant, there is no evidence yet to suggest that it is superior to subglandular placement.  From a logical standpoint, and knowing the anatomy and physical characteristics of the pectoralis fascia, there is no reason to believe it should be different from subglandular augmentation.  This fascia is so thin it is translucent, and therefore has no physical protection it can afford the implant, like the muscle itself. Because it is so thin, it has no elastic support either. 

As I have said so many times, doctors should try to avoid making subjective opinions, and let evidence from clinical science direct our practice.  If that is the case, then breast augmentation using an appropriately sized implant delivered through an inframammary or armpit incision, and placed in a partial retropectoral position will lead to the most natural result with the least complications.

Best of luck.

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

Subfascial breast implant placment is not a rare technique though some market it as such

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 Thank you for your question.  Yes, a subfascial implant placement is possible. To see if you qualify and are a candidate for this technique, see at least two or more board-certified plastic surgeons in your area.  When you call to make the appointment, ask: 1. Does the surgeon perform a subfascial technique for breast augmentation, and 2. Does the surgeon have access and use Style 410 "gummy bear" implants.  Good luck.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 214 reviews


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There are many Plastic Surgeons using this approach.  To be a candidate for the subfascial approach you need enough soft tissue coverage in the upper aspect (upper pole) of the breast.  I would contact several Plastic Surgeons in your area to see if they offer what you desire.

Todd B. Koch, MD
Buffalo Plastic Surgeon
4.6 out of 5 stars 37 reviews

Sub-fascial breast augmentation

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By placing a breast implant under the fascia (thin tissue that overlies the chest muscle) you are providing less coverage than by going under the muscle My opinion is that anything above the muscle should be sub-fascial but depending on the implant size you choose, I think it provides less optimal coverage. There are many qualified board-certified plastic surgeons all over the country and I don't feel you need to travel to be well taken care of. I hope this helps.

Dr. Edwards

Subfascial breast augmenation and gummy implants

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First, subfascial breast augmentation offers nothing more than a subglandular coverage in my opinion. Second, gummy implants are not yet avaialbe to the general public. It is still not approved for general use and is only used under special research protocols.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.