Partial Submuscular, Total Submuscular, or Subfacial Position - Which is Better?

which would you prefer, for a 500cc silicon implant? i'm worried about how real they'll feel? will subfascial still give me the benefit of under the muscle for feel real wise?

Doctor Answers 8

The advantages of subfascial placement in breast augmentation

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I use pretty much exclusively subfascial placement in my practice.  There are many anatomical and surgical studies that have been published confirming the existance of a strong fascia overlying the pectoralis muscle that can indeed be elevated to transform the shape of augmented breasts.  The dogmatic answer is either that the fascia does not exist or cannot be elevated.  I have been so impressed by the difference that the fascia makes in my ability to create beautiful projection tear-drop shaped breasts that I developed a technique that I call 'cold-subfascial augmentation.'   In this approach I directly sharpely separate this valued layer from the muscle under direct visualization and indeed once elevated the glistening white layer is apparent.  The structural support allows me to shape the breast precicely for the patients chest wall dimensions.  After working with Dr, Ruth Graf, the innovator of this technique, and seeing her 10-15 year followup without revisions I had even more faith in this technique and truly believe over time patients recieving true subfascial placement will have greater long term satisfaction and less revisionary work.  I hope this helps!  


All the best,


Rian A. Maercks M.D.

Partial Submuscular, Total Submuscular, or Subfacial Position - Which is Better?

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Partial Submuscular, Total Submuscular, or Subfacial Position - Which is Better? The chocei varies by individual and therefore it is not a simple answer. Subfascial is not a popular choice and its effectiveness or equivalence to submuscular has not been substantiated

Pocket location for implants

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I prefer partial submuscular in most thin patients.  I do not think a subfascial pocket affords any advantage.

Technical questions before breast augmentation.

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1)  You need to have a plastic surgeon you trust to answer these questions specifically for you after examining you.

2)  500 cc breast implants are too big for most women.  Huge implants age very badly.

3)  The subfascial approach has no advantages.

4)  Total submuscular approach is never used for breast augmentation. (It is useful in post-mastectomy breast reconstruction.)

5)  The choices are subglandular, subpectoral (partially submuscular), or dual plane,  and which is best depends on your anatomy.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Options for implant placement allow for individual needs to be balanced

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There are several variations now that balance the often competing needs for implant coverage with the problems that can occur with going under the muscle. Although most implants are placed under the muscle, using traditional techniques it is necessary to cut the muscle or the implant rides too high. This means that the majority of women with submuscular implants experience some degree of distortion of the breast with muscle flexion, called animation deformities. Using a split muscle technique, you still get coverage of the upper part of the breast where it is most important but avoid the animation problems. Subfascial is just starting to catch on in the U.S. though I have been doing it for 6 years and it has been popular in South America for longer. The fascia is thin but tough so it adds support but not "padding" for coverage. If you are interested in determining whether these are right for you then I would recommend finding a plastic surgeon who has done them personally.

More info here:

Pictures here:

Article: Subfascial Breast Augmentation: Theme and Variations.
Aesthetic Surgery Journal 25(5);447-53, 2005.

Three choices, not really

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Having done many augmentation both above and under the muscle there are pros and cons to each.  I am not a believer in the subfascial plane as this appears to me to be a subglandular with very little additional tissue.  Unless you are a professional athlete I would place the implants subpectoral.  They ripple less, stay softer, are better for mammogram and look more natural especially in a thin patient.  

Placing the implant entirely submuscular in my opinion gives an abnormal result without a defined crease and a mound.  Remember that there is no muscle in the breast so the reason it is partial submuscular is to try to achieve the best of both worlds.  I do occasionally place the implant subglandular.  This has the advantage of less pain, no motion on muscle contraction and slightly more projection.  Good luck with your decision.

Breast Implant Placement

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In the vast majority of patients, submuscular placement is the best option.  If the muscle is not divided, the implants tend to "ride high," meaning that the muscle pushes them up to high and the implant looks fake.  In partial submuscular placement, the inferior (lower) portion of the muscle is divided and allows for a more natural position of the implant.  Good luck with your surgery.


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In terms of implant placement, the best position is the submuscular placement.  All submuscular implants are really partial submuscular - none are completely surrounded by muscle.  To do so would require lifting up some side chest muscles and upper abdominal muscle, along with the pectoralis muscle.  This is almost never done, so all the implants are usually just under the pectoralis muscle.  Depending on your anatomy, the implant may be covered 1/3 - 3/4 with the pec. muscle.  Going subfascial does not really provide you with any benefit.  You want the muscle coverage over the superior part of the implants to help hide the implant itself where everyone is very thin.  I hope this helps.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.