Subfascial implant placement?

Question

I am 37 years old, very fit and active and am seeking a lift with smaller implants (250cc). Pregnancy and childbirth wrecked my breasts and they sag and shrank so the aim is to restore them to their former glory. In my consultation, the dr. recommended over the muscle/subfascial due to my active lifestyle and affinity for lifting weights. I realize this carries a higher risk for capsular contracture. Is this what you would recommend?

Joe Gryskiewicz, MD, FACS · Answer

Hello, if you are active, and lifting weights I would suggest placing your implants subfascial. This will decrease your chances of developing any muscle deformity that can happen when the muscle pushes on the implant overtime. If the surgeon is placing the implant on top of the muscle but under the subfascial lining the risk of developing a capsular contracture is the same as if you placed the implant submuscular.

James M. Economides, MD, FACS · Answer

It’s great that you’re considering all aspects of your surgery, especially in relation to your active lifestyle. The decision between over-the-muscle (subfascial) and under-the-muscle implant placement has pros and cons, and your doctor's recommendation is likely based on how active you are and your goals for both aesthetics and functionality.

Here’s some insight into the subfascial (over-the-muscle) placement for someone with your fitness level:

Pros:
Less Interference with Muscle Function: Since the implant is placed over the muscle, your chest muscles (particularly the pectoralis major) are not disturbed. This is beneficial if you lift weights, as it minimizes the chance that your implant will move or be distorted when flexing your muscles during exercises like chest presses or push-ups.

Faster Recovery: Recovery from subfascial placement is typically quicker than under-the-muscle, and there may be less post-operative pain because the muscle isn’t manipulated.

Natural Look: With smaller implants (like your 250cc choice), over-the-muscle placement can still provide a natural look if there’s enough soft tissue coverage. This is a good fit for someone looking to restore a pre-pregnancy appearance.

Cons:
Higher Risk of Capsular Contracture: As you mentioned, subfascial implants can carry a higher risk of capsular contracture, which is the formation of scar tissue around the implant. This is something to consider, but techniques like using textured implants or proper post-op care can sometimes help reduce this risk.

Less Soft Tissue Coverage: Over-the-muscle placement relies more on your existing breast tissue to cover the implant. If your breast tissue is thinner (common after pregnancy and weight loss), this can sometimes lead to the implant being more visible or palpable.

Under-the-Muscle Option:
This method tends to be more popular for those looking to minimize the risk of complications like capsular contracture and achieve a more natural look in thinner patients. However, for very active individuals, it can cause some issues with chest muscle movement or discomfort during intense workouts.

What You Might Consider:
Discuss Capsular Contracture Prevention: Ask your surgeon about how they plan to minimize the risk, whether it's through specific surgical techniques or post-op care.
Balance Aesthetics and Function: If you have sufficient breast tissue and your main priority is maintaining your ability to lift and stay active, subfascial placement might be a good option. If capsular contracture is a significant concern, you might want to explore under-the-muscle placement further with your surgeon.
Given your active lifestyle, the over-the-muscle/subfascial approach could indeed suit your needs, but it’s important to be clear with your surgeon about all your concerns, especially regarding the balance between aesthetics, the risk of complications, and how your implants might behave during exercise.

If you’re still unsure, you could always seek a second opinion, but your surgeon’s recommendation seems aligned with your active fitness routine.

Daniel Barrett, MD · Answer

Dear kalgal14,
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

Richard Baxter, MD · Answer

The fascia is a thin but strong layer that can be used to form a barrier between the implant and the breast tissue, so it isn't the same as subglandular. Any possible increase in capsular contracture risk is very small. It avoids problems of animation deformity which is a potentially significant problem with weight lifting and sports.

Sean Fisher, MD · Answer

The answer to this question is dependent on a number of factors. One is certainly your lifestyle- for patients who are very active, frequently lift, and are worried about animation deformity- subfascial augmentation can be a great option. However, it is also dependent on anatomy- For those patients with less native breast tissue, a subfascial augmentation will have a greater risk of a more clearly augmented appearance or rippling. If patients have little native breast tissue but are only interested in above the muscle augmentation, fat grafting can be considered to camouflage the implant. Regarding the risk of capsular contracture, we do not have great long-term data regarding rates as compared to submuscular implants. You are correct that when comparing subglandular to sub-muscular implants, there is a higher risk of capsular contracture. Subfascial augmentation may be a great option for you based on lifestyle and a well qualified surgeon should be able to give you an honest assessment based on a focused exam and discussion of your goals.
Sean Fisher Aesthetic Plastic Surgeon Seattle, WA

Subfascial implant placement?

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Answer: Subfascial breast implant placement is a great option

Answer: Subfascial breast implant placement is a great option

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Answer: Subfascial vs sub-muscular

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Subfascial implant placement?

Answers (6)

Answer: Subfascial breast implant placement is a great option

Answer: Subfascial breast implant placement is a great option

Answer: Subfascial vs sub-muscular

Answer: Subfascial vs sub-muscular

Browse related questions

Recommended reading

Everything you need to know about Breast Lift with Implants

Our mission is to create a world where every investment in modern beauty is Worth It.