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.

Dear Mayo,If you are really into fitness, I think you are on the right track.. I do a lot of competitors, some featured on my web site, and this avoids the migration down and out as well as the animation/window shade deformity from under the muscle.  You might have more visible wrinkles, so inquire about the Mentor XTRA (MGX) which I always use form my "gym rats."  Good Luck, Dr. Joe

The fascia is not very thick compared to the muscle so you can have more implant rippling.  If you have a decent amount of breast tissue prior to augmentation, than it shouldn't matter.  

Hello,From an outcomes standpoint, subfascial surgery has not been proven to be in any way different than subglandular surgery. The prepectoral fascia is an extremely thin veil of tissue that is almost non-existent in the upper region of the pectoralis muscle, and dissecting under it typically leave it with little physical integrity; placing of the implant almost certainly ruptures it. Regardless, it offers no tissue to buffer/cover the implant, which easily leads to implant palpability/visibility, and the risk of capsular contracture is the same as subglandular. Avoiding animation deformity is easy when a properly chosen implant size is chosen. Go visit a few ABPS certified/ASAPS member surgeons who specialize in breast surgery. Best of luck!

Dear mayo90,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

implantation under the muscle was initially started to eliminate  upper pole wrinkling and to provide greater coverage over the implant. The subfascial approach was first described as an option to eliminate the muscular animation one sees with that placement. Not all patients really mind the animation, but the procedure is more painful than subglandular. the fascia overlying the pectoralis muscle is tenuous, and friable. it is adherent to the muscle, and more bleeding is encountered with that attempt. Further, the fascia is not complete over the entire muscle, and is difficult to elevate. thus, it might be best to place the implant under the breast as an alternative. Good luck with your decision.

To me, subfascial implants have the same risks of placing them subglandular.  Yes, submusuclar can cubes some animation issues, but I think the benefits outweigh the risks in most cases.

Subfascial placement is an excellent option because it avoids an animation deformity in patients who are concerned about this. The tradeoff is that if there is inadequate soft tissue coverage( not enough breast tissue) there is a higher risk of rippling with the implant. However, choosing an implant with a greater degree of cohesivity can minimize this risk. See a board certified plastic surgeon who performs may cosmetic breast procedures.Regards,

Dr. Ravi Somayazula

Board Certified by the American Board of Plastic Surgery- American Board of Medical Specialties

Member of the American Society of Plastic Surgeons (ASPS)- Subcommittee Task Force on Patient Safety

Member of the American Society of Aesthetic Plastic Surgeons (ASAPS)

Member of the Texas Society of Plastic Surgeons, Houston Society of Plastic Surgeons, Harris County Medical Society