How to decide between subglandular and subfascial plane?

These are different techniques and the one who should make the decision is your surgeon based on the clinical examination and your body. The subfascial plane is not for everyone since the fascia can be very thin and flimsy in some people and you won't know until the surgeon is working on it. Subglandular plane has the most complications long term.

Dear ggreguer77664,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

Subfacial is synonomous with sub muscular. In a very thin individual, submuscular is preferred. With tubular breast, radial incisions in the breast tissue is required.Subglandular placement has a higher risk of capsular contraction and ptosis. Should only be done to provide lift to the breasts and in someone with thick tissue over the muscle.Hope this helps.

Yes, subfascial implant placement is superior to subglandular in terms of long term aesthetic outcomes in terms of overall breast shape, lower rate of capsular contracture, and fewer visible folds and ripples. There is a blinded, randomized, prospective study with 5 year followup (and MRIs at 5 years demonstrating the thickness of the capsules) showing exactly this. For these reasons, I do not perform subglandular breast augmentations and only perform subfascial or submuscular breast augmentations, depending on your goals or anatomy.

There are many plastic surgeons that have difficulties to accept concept of subfacial breast implants placement. In most patients pectoral muscle fascia is so thin in distal portion of pectoral muscle that it is impossible to dissect it from the muscle and create a true subfascial pocket. So, in almost all cases patient with subfascial plan implant placement end up with subglandular placement. Hope this helps.

If you are thin, I would suggest submuscular or subfascial placement for better implant support and coverage, and better upper breast fullness. Otherwise, you may see the edge of the implant and have only your skin to help support the additional weight. Some women claim they have tuberous breasts when only the breasts are just sagging. Tuberous breast has a small breast base, often does sag, often has very large areolae, and is shaped like a tuber, long and skinny.

In my practice the majority of patients select to have their implants placed beneath the muscle. There are some great benefits to this choice. The muscle does provide a bit of camouflage for the upper portion of the implant, concealing the edges and rippling/wrinkling. This is particularly helpful for those with thin itissue. It also carries a lower incidence of capsular contracture. Patients also often prefer it as they feel it provides a more natural look.

In my opinion and experience, there is very little difference. The pectoralis muscle fascia is excedingly thin and offers very little support or benefit, especially when compared to sub muscular. For a thin woman with little breast tissue, I would definitely recommend sub muscular. Mammograms are better, less chance of drooping and lower incidence of capsular contracture. Better in every way except that it is more painful. But, for that reason, I use an On Q pain pump which gives you numbing medicine for the first 5 days and helps dramatically with the pain.

I suggest you look at some images of pectoralis muscle anatomy.
You can do this with a simple Google search.
If you study the anatomy of the porous muscle, you’ll recognize it doesn’t have a fascia over the main part of the muscle.
There is only fascia around the origin and the tenderness insertion of the muscle. There is no sub-fascial plane of the pectoralis muscle where the implant sits.
I don’t know why some plastic surgeons continue to refer to this anatomic plant that doesn’t exist.Breast implants are either above the pectoralis muscle, below the pectoralis muscle or placed above and below in a procedure in a procedure called bi-plane when the pectoralis muscle is transected higher up.
In reality, the lower part of the implant is usually never covered by pectoralis muscle.
In sub pectoral placement, the surgeon makes a decision where to cut the pectoralis muscle. In my opinion, it is advantageous to leave as much pectoral coverage over the implant as possible without leaving the implant riding high.
Some of the terminology and descriptions will border on technical and without a good understanding of how the procedure is performed, it may be difficult to comprehend exactly what each term represents.I suggest focusing a reference on provider selection, which in the end is the most important variable.
My experience has been that the best plastic surgeons who have the most breast augmentation experience almost all use sub pectoral approaches to breast documentation.
To me the main advantage to putting the implant above the pectoralis muscle is that it’s technically much easier and faster.
There are other differences and technical ease may not be the only reason to choose sub glandular replace.
Personally, I don’t believe there is a sub facial plane that is any different than sub glandular and again I don’t know why plastic surgeons continue to refer to this an atomic plane that doesn’t actually exist.
Look at the anatomical references for yourself and make your own conclusion.
Best,
Mats Hagstrom MD