Is the subfascial technique safe?

Question

My surgeon wants to try the SF placement because I am a fit active person and into weighlifting. I have read that it has the same rate of Capsular contracure than subglandular but then I have also seen recent studies that show it does not but there is a lack of research that ahow the long-term of this placement. Is this placement safe in the long term? And is capaular contracture really lower than Subglandular?

Joe Gryskiewicz, MD, FACS · Answer

Hello,
The subfascial technique is very safe. I highly suggest any patients who are active and or lift weights to have implants placed under the subfascial lining. It has the same rate of capsular contracture if not a little less. 
All the best,
Dr. Joe

Daniel Barrett, MD · Answer

Dear Enthusiastic923585,
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

Irena Karanetz, MD · Answer

Hello,
 
Thank you for the question.

Subfascial breast augmentation technique is safe, and may be associated with lower capsular contracture rates when compared to sublgandular breas augmentation.
 
In addition, placing the implants above the muscle (subglandular or subfascial plane) can help minimize animation deformity (when implants move during weightlifting).  However, not everyone is a candidate for above the muscle breast implant placement because if the breast tissue are very thin, implant rippling may be more pronounced in the upper pole of the breast.
 
Implant size discussion and implant selection is one of the most important steps during your consultation with plastic surgeon. The decision-making process depends on patient’s desires, as well as breast and soft tissue dimensions.
 
I would encourage you to seek a consultation with a Board-Certified Plastic Surgeon to further discuss your options, specific techniques, concerns and expectations.
 
I hope this helps.
Best regards, Dr. Karanetz
 
Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon

Jeffrey M. Darrow, MD · Answer

While capsular contracture is possible after any breast augmentation, the 14 step protocol of Dr. Bill Adams, for preparing patients and their skin prior to a breast augmentation, has decreased the rate of capsular contracture down to less than 1%.  Performing a sub facial breast augmentation gives one additional layer of tissue between your breast tissue and the implant. It is excellent choice if you would like to minimize the risk of implant animation after your breast augmentation.  The lifetime risk of capsular contracture after breast augmentation is 8 to 12%. This is decreased whether the implant is put under the breast, under the fascia or underneath the muscle.  Other factors impact upon the risk of capsular contracture, including a PERSONEL/family history of auto immune disease, choice of a large implant, etc. Have a detailed discussion regarding your choices with your plastic surgeon. Best wishes.

Ted Eisenberg, DO, FACOS, FAACS · Answer

This method is tried and true in the long term with low capsular contracture rate. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Jeffrey Lisiecki, MD · Answer

The best study we have on this, which was a randomized prospective trial comparing subglandular versus subfascial breast augmentation with 5 year clinical and MRI followup (that is an impressive study!) showed that subfascial breast augmentation has significantly better breast shape and contour and significantly lower capsular contracture than subglandular.  So yes, subfascial has lower capsular contracture and better shape than subglandular.  In my practice, I do not perform any primary breast augmentations subglandular, and only go subfascial if we are doing "over the muscle."

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided photographs or told us your bra size. When implants are placed in front of the pectoralis major muscle in the subglandular position then the major nerves are cut. The same is true with subfascial positioning of the implant. The retro-pectoral positioning does not cut the major nerves to the nipple-areola complex. However, the implant can be extruded inferiorly and laterally. You may be better off with smaller implants submuscular then subfascial.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

The lowest risk of capsule formation is with saline implants placed behind the muscles. However, the risk of capsules with the new gel implants is fairly low, regardless where they are placed. Your surgeon is trying to give some coverage but avoid the excess muscle flexion.  I still prefer placing the implants behind the muscle in most women.

Camille Cash, MD · Answer

Yes, either approach is safe.  However there are definite benefits to placing implants beneath the muscle.  In addition to lower incidence of capsular contracture, the muscle helps to disguise the upper portion of the implant which can camouflage ripples, wrinkles, etc, and patients report they feel it gives a more natural appearance to the breast.

Serkan Kaya Ekinci, MD · Answer

Hello, I am Serkan Kaya Ekinci. I will answer your question with pleasure. Actually, it is not a very old technique. The subfascial technique started to appear in the literature in 2002. Subfascial technique is not a frequently heard technique such as under the muscle or under the breast, but its use is increasing due to its high advantages. In this technique, silicone is placed under the membranes of the muscles above the breast. It varies from patient to patient. If your doctor recommends it, get it done easily.

Is the subfascial technique safe?

Answers (12)

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