Recovery for subfascial breast augmentation? Is this my best option?

After several consults, I've found an excellent top board certified plastic surgeon I get a long great with. He recommended subfascial placement as he felt they yield the best, longest lasting results. I'm 5'4'' 110lbs A cup wanting a natural C or a full B. Submuscular the only option at another consult. Was told that because it's faster, easier surgery to preform most surgeons will choose it. Is the recovery of subfascial less painful than the submuscular?

Doctor Answers 12

Subfascial versus Subpectoral

Great question.  There are some important aspects of both subfascial and subpectoral implant placement that may be helpful to consider to make a good decision as to whats best for you.  In general, the thinner you are the more beneficial the extra layer of tissue from subpectoral placement is to the overall look and feel of the implant.  The thinner you are the more important it will be to also consider the type of implant as the shaped (aka anatomic or teardrop) silicone implant will be in providing a natural result.

Subfascial placement provides a quicker recovery.  It also eliminates the muscle as part of the equation so animation (movement of the breast with muscle contraction) is avoided and cleavage can be created to the extent desired as opposed to limited by the muscle insertion.

Longevity is more a matter of the size and type of implant as well as how the pocket was created as opposed to where the implant is placed (under or over).

In general, try imagine where you would like to be a year after your breast augmentation to help you decide on which method will be best for you.  The recovery period is important but that will soon pass and you should then be left with the type of augmentation result that you desire.

In my practice I perform about 50/50 in terms of patients receiving subfascial versus subpectoral.  I make most of my recommendation based on patient desire as well as the thickness of the overlying breast tissue.

All the best,

Dr. Remus Repta

Scottsdale Plastic Surgeon
4.9 out of 5 stars 162 reviews

Subfascial vs sub muscular breast augmentation

Subfascial surgery is less painful than sub muscular however this should not be the reason to choose placement of the implants. Even sub muscular breast augmentation causes pain for only a few days that is very manageable with pain medication. There are pros and cons of each pocket location and you can discuss these with your surgeon. If you are thin I would typically recommend sub muscular implant placement for a more natural look unless you go with anatomic or shaped implants. There is little data to support subfascial as being superior to sub muscular implant placement but this is still an acceptable and reasonable approach to breast augmentation. Good luck!

Josh Olson MD

Josh Olson, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 89 reviews

Subfascial versus subpectoral

There are pro's and con's for each of these pockets or where we can potentially place your implants. Although we all want to minimize your downtime and pain, I would not base your final decision on this. At 110 pounds and an A Cup it does not sound like you have much tissue coverage for your implant. In that case submuscular could be better for you specifically. Subfascial can be a nice choice for women with adequate tissue coverage, who have wide set breasts that could not be made closer under the muscle or those women who aggressively work out their upper body where animation or malposition could be a problem. Exparel, is a long acting medication that can be injected during your surgery to help manage your pain as well. 
Good luck!

Jennifer Geoghegan, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Breast Implant Placement

Yes. Recovery from subfascial placement is less painful than submuscular. There are, obviously, pros and cons to each, but it sounds as if you and your doctor have discussed these and come to the right recommendation for your specific body.

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Subfascial breast implants

There is good data about the site at which implants are placed. Because the fascia is quite thin these behave more like a subglandular implant. Only patients with a fair amount of overlying breast tissue should consider this aproach. It does have a higher rate of capsular contracture than implants placed below the muscle. I find the post op pain is less however. Each surgeon has their own preferences and none are wrong. Good luck

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Subfascial imlant

Thank you for your question. It is wonderful that you have found the surgeon that you feel is the best for you. That trust will help you do well through the entire process. Each of us have different experiences and reason why we prefer one method or one implant type over another. Ultimately, most of these choices end up with very nice results. The subfascial approach does take a bit longer to do, and pain levels will vary quite a bit. I would stick w/ the surgeon that you are most comfortable with. Best wishes.

Paul J. Leahy, MD
Leawood Plastic Surgeon
5.0 out of 5 stars 7 reviews

Subfascial breast augmentation

Thank you for asking. There are distinct pros and cons. In general the subfascial position is less tight and patients tend to feel more normal more quickly. There is also less muscle action upon the implant. The longevity historically has been better with submuscular positioning as there is more coverage over the implant however specific patients need specific counseling. The breast envelope, implant volume and pocket overall help determine the longevity. Hope this helps. Best wishes

David C. Yao, MD, FACS
Phoenix Plastic Surgeon
4.8 out of 5 stars 7 reviews

Implant pocket

Recovery from breast augmentation surgery is generally very quick regardless of which pocket is used.  This should not shorten or prolong your recovery.

John L. Burns Jr., MD
Dallas Plastic Surgeon
4.7 out of 5 stars 42 reviews

Submuscular implant

Most patients seem to do better in the long term with submuscular placement of the implant.  The muscle helps to give a more natural look.  Sub fascial placement is just another way of saying over the muscle.  The fascia is very thin and does little to affect the result.  It is always best to think long term rather than to focus on the short term recovery.

Terrence Murphy, MD
Englewood Plastic Surgeon
4.8 out of 5 stars 28 reviews

Subfascial vs submuscular breast augmentation recovery

Thank you for asking about your breast augmentation.

  • If your chest is very thin, implants under the muscle will give you a more natural look.
  • Implants under the fascia are essentially the same as  implants over the muscle - except that it causes pain by lifting the muscle fascia.
  • Implants under the muscle are also painful.
  • Under muscle implantants are done NOT because of less pain but to reduce the risks of capsules and of infection - the recovery without Exparel is very pain for 3 days for most people and it takes 2 weeks - 6 months for implants to settle in a natural position.
Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 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.