Can a subfascial placement prevent a lift? Am I a good candidate for breast augmentation?

Question

I have been to three consults, and am still unsure about whether or not I am a good candidate for a breast augmentation. I am scared I’ll achieve results where my breasts are far apart and my nipples are low and pointing down. I am interested in subfascial placement after a ton of research, but only one surgeon in my area does it, and I got a weird vibe from the consult.

Finny George, MD · Answer

Hi, thank you for sharing your question. You are a great candidate for breast augmentation with a dual plane approach, which has a lower risk of capsular contracture than the subfascial approach. I do not recommend subfascial to my patients, but your surgeon will be able to guide you appropriately. With a dual plane, your breasts will not move further apart, nor will your nipples point/sit lower. I hope this helps.

Ronald J. Edelson, MD · Answer

Your best option is a lift with implant the lift you should look into is often called the lollipop lift. It has fewer scars and gives great results. Don't get talked into a donut lift. Not every surgeon knows how to do the lollipop lift so that's why you are getting advice for other things which will not work out.

Daniel Barrett, MD · Answer

Dear SaraPitt,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mark Eberbach, MD · Answer

There are two issues you are facing. Volume loss and tissue stretch. An augmentation either subfacial, sub glandular or sub muscular will solve the volume problem but not the tissue issue.

You will need a breast lift as well to get a result most like your wish picture outcome.

Good luck.

Darryl J. Blinski, MD · Answer

To me appears as you would need a lift whether you the implant is sub muscle or dual plane/subfacial. Best to obtain more in person consultations.

Ernst Magnus Noah, MD · Answer

Dear Sara,I performe subfascial breast augmentation- but I work in Germany.We use textured implants, and anatomical shape, to my knowledge and experience it’s the only way to get the desired lift.Prof. E.M. Noah

Joshua B. Hyman, MD · Answer

Great question! The placement of the implant will NEVER prevent the need for a lift. Some surgeons think placing the implant in the sub-glandular position or sub-fascial will prevent the need for a lift but it simply won't happen and is actually a common mistake in the less experienced or novice surgeon. Another common mistake is for the surgeon to place larger implants to get more of a lift. The good news is sometimes mastopexy scars heal beautifully. I think you would only need a small or short incision mastopexy.

Richard P. Rand, MD, FACS (retired) · Answer

Basically, there is very little "fascia" on the pec muscle so a "subfascial" placement is essentially the same as subglandular or above the muscle. That is why hardly anybody does this surgery as submuscular placement is better. Above the muscle placement does not lift the drooping breast as nothing can do that other than a breast lift combined with implants for size enhancement. Submuscluar implants are always better especially when considering future mammograms and capsular contractures.

Your tissue elasticity has been damaged by pregnancy and weight gain and probably needs a full breast lift plus implants to approach the look in your goal photos where the breasts are full and the nipples are elevated and properly located. Without a lift, you will not look like this. Also, a lift is needed to correct your asymmetrical nipple positions. I would suggest that you see Dr. Ken Shestak in Pittsburgh for another consult.

Can a subfascial placement prevent a lift? Am I a good candidate for breast augmentation?

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