What are the advantages and disadvantages of sub-glandular versus sub-fascial?

Question

Considering silicone rather than saline, which of the two approach procedures came about first in the industry ? What are the advantages and disadvantages of the two ? Is it true that sub-glandular will give a more 'fake' look ? Whereas sub-fascial offers a little more natural support for larger sized implants such as 700 cc silicone ?

Joubin Gabbay, MD · Answer

I feel that this difference is more a marketing tool than anything which will provide a different results. In general, I strongly recommend augmentation underneath the pectoralis muscle to give the best and most natural results.  Sub glandular or subfascial implants have substantial disadvantages that I try to avoid!The most important thing in choosing the correct breast augmentation is to find a surgeon who is certified by the American Board of plastic surgery.I wish you the best!Dr. Gabbay.

Michael E. Decherd, MD, FACS · Answer

I think that in general sub-muscular is a better approach than sub-glandular.  I think it looks more natural, it is better supported, and since tells us there is less capsular contracture.  Oh and less symmastia.As far as subfascial, Let me quote John Tebbetts, "Is adding less than a millimeter of additional soft-tissue coverage over a breast implant logical compared with adding more than 100 times that amount of coverage, if techniques are available that equalize tradeoffs and morbidity of subfascial versus pectoralis coverage?"  (In October 2004 PRS)So I do not think a thin layer of fascia adds a lot.

John Dean, MD · Answer

Silicone implants were available first, starting in the mid 1960's.  They were placed in the subglandular position and had a lot of complications, such as capsular contracture, so that alternatives were devised.  Implants were placed behing the chest wall muscles and saline implants were used.  Both of these helped with capsular contracture but also caused some issues of their own.  Silicone implants were off of the market for almost 20 years, while the FDA reviewed their safety data but now are available.  Choosing the implant type and the anatomic position for each patient is a very individual surgeon and patient choice and no way is better than the others in all situations.

Bryan Correa, MD · Answer

The difference between these two locations is virtually negligible, especially when it comes to supporting an implant that is 700cc.Silicone was available first; the primary advantage is a more natural feel.

Tom J. Pousti, MD · Answer

Thank you for the question. There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. The vast majority of breast implants placed in the "sub muscular" position are really being placed in the "dual plane" position ( partially sub muscular, partially sub glandular). 
I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.

On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in the sub muscular position.

I hope this, and the attached link, helps. Best wishes.

Ronald V. DeMars, MD (Retired) · Answer

They are basically the same. If you could see the fascia of the pectoralis muscle, you would realize it is extremely thin and weak and has about as much support as a layer of kleenex. The best approach for the most natural look in most patients is submuscular with a dual plane.

What are the advantages and disadvantages of sub-glandular versus sub-fascial?

Answers (6)

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