Disadvantages to subfascial breast augmentation?

Most surgeons in North America are unfamiliar with subfascial implant placement as we are predominantly taught to place implants underneath the muscle.  In the correct patient, implants placed over the muscle work very well.  The advantages are less pain/recovery time, no animation deformity and in certain cases a better shape of the breasts than submuscular placement.  Often a lift of the breasts can be avoided by placing the implants above the muscle.The fascia is a thin layer, but I do believe that it can provide more support and an additional soft tissue layer between the skin and the implant.  As I place implants through an armpit incision with an endoscopic approach, the fascial layer is fairly easy to elevate when dissection proceeds in a downward direction.  When a surgeon begins with an incision on the breast, this layer is more strongly adherent and much more difficult to elevate correctly.If you are considering implants placed above the muscle, please seek a board certified plastic surgeon that is familiar with the nuances of this approach and has done sufficient procedures to give you the best results.

I recommend dual plane behind the muscle.  The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

There are pros and cons of all decisions we make in life. Sub fascial placement does eliminate animation deformity. However it does come with its own baggage. There is a higher chance of seeing ripples or feeling the implant, even if the more firm gel implants are used. This can also be seen in particular in the upper cleavage area which you do not see with sub muscular. There is also controversy as to whether this increases the risk of capsular contracture. Animation deformity can vary dramatically depending on one's anatomy. Often it depends on the amount of pre-existing breast tissue, the degree of looseness of the skin, and where one's breast resides relative to the muscle. Choosing between submuscularl and sub fascial is difficult. There are many professional bodybuilders that have chosen sub muscular without issue. The experience of your surgeon plays a big role in this also.