Is subfascial breast augmentation a good option? (Photo)

For active and athletic women I think the most important factor to an excellent outcome is the base width diameter and not whether it is above the muscle (subglandular) beneath the muscle (submuscular) or beneath the thin lining of the muscle (subfascial).For athletic women you want to make sure that the implant does not "overwhelm" the appearance of a thin, or muscular torso. I find that implants that are too wide for a patients are frequently used which then distorts the athletic shape.For the very infrequent occasion when you will be flexing the pectoralis major muscle while someone is looking at your breast in a swimsuit or exercise top then placing the implant above the muscle or beneath the fascia would limit or eliminate distortion or animation.If you would like more information regarding breast augmentation you can download my free breast augmentation planner at aBetterBreast.com

Thank you for your picture and question.Congratulations on your decision to undergo breast augmentation surgery. The choice is yours in the end if you want to have sub-pectoral or sub-fascial placement.I favor the subpectoral placement for breast implants. The placement of the implant is in a dual plane --- meaning the top half of the implant is under the muscle while the bottom half is under the gland. The capsular contracture rate is lowest if the implant is placed under the muscle, in this manner.I hope this helps.- Dr. Bryson Richards

I think a sub fascial implant position will help with animation deformity. The trade off is that there is less soft tissue coverage over the implant (making its edges more visible) and the rate of capsular contracture may be higher in the sub fascial position, although that issue is not completely understood at this time.

Thank you for your picture.  There is no science that Subfascial  augmentation reduces capsular contracture. I do not think there's any benefit to subfascial versus subglandular augmentation. 

Pectoralis Muscle fascia is about a thick as a single piece of typing paper so would not give you more soft tissue padding which is most important for small breasted women. I would recommend a submuscular position as there is more soft tissue padding between the implants and your skin. To minize motion with lifting and exercise which is your major opjection to a submuscular placement, consider textured implants (I prefer Sientra) which tend to stay in place due to capsule ingrowth - therefore minimizing these concerns. 

Yes!!!  In my practice, the majority of our patients prefer subfascial placement of their gel implants.  A provide for a natural result, and reduces the risk of animation deformity following submuscular implant placement.  Animation deformity is one of the major reasons that many surgeons prefer subfascial implant placement.  In my practice, I used that almost exclusively.  In my experience, It works best however with gel type implants.

Your concerns with submuscular/dual-plane augmentation are very warranted.  The typical submuscular round silicone breast augmentation is very likely to emphasize the space betwee your breasts and cause the animation deformity you are concerned with.  True subfascial placement can correct this in skilled hands but be careful,  there are many that claim they perform subfascial but in reality are delivering subglandular results and there is a BIG difference.  The pectoral fascia is a very thin layer that can be easily damaged or destroyed by rough dissection or electrocautery.  THius is why I use a technique called "Cold-Subfascial BreastAugmentationR"  that preserves the fascia in its entirety and allows the use of its full strength to shape the breast and support its long term result.  Dr. Ruth Graf, one of the early proponents of Subfascial Breast augmentation delivered a paper just weeks ago at the International Society of Aesthetic Plastic Surgeons Congress in Brazil documenting an unparallelled less than 1% incidence of capsular contracture in subfascial cases.  Leaders from around the world have had similar findings as I have as well.   It is very likely in the near future that we will have widespread agreement that subfascial placement is associated with the lowest incidence of capsular contracture.  I delivered a paper on the Cold-Subfascial technique at the same congress in Brazil and am hosting surgeons from around the world to observe this technique.  It is the only technique I perform because in my hands it delivers results that are vastly superior to other techniques.  I would recommend finding a surgeon well versed in subfascial technique and with experience using anatomically shaped form stable implants which will give you the most naturally appearing results.  I would also strongly advocate a transaxillary route as you have very nice breast anatomy and there is no need to place scars on your breasts.  I hope this helps!All the best,Rian A. Maercks M.D.

Sub-muscular breast implant placement has been shown to have a lower capsular contracture rate compared to sub-glandular implant placement. There are no long term studies I am aware of that shows sub-fascial implant placement has this same benefit. In my practice only competition level body builders have a concern regarding breast implant distortion by the pectoral muscles. For the vast majority of breast implant patients this has not proven to be a significant concern. Looking into the future, if you ever needed to have a breast lift then this operation is much safer if the breast implants are sub-muscular. Sub-glandular placement of implants disrupts more of the normal blood supply to the breast tissue and skin making breast lift a riskier operation. I hope this information is helpful in making your final decision.

To be perfectly honest, there is not a large difference from sub muscular to sub fascial implant placement. If you are an aggressive weight lifter (BTW the posted photo to me does not demonstrate that) than consider above placement... 

Good question but the answer is not as clear cut. In most cases, I feel that sub muscular placement is better than sub glandular. Subfascial placement is definitely not sub muscular but not truly subglandular either. It has it's benefit over true subglandular placement by theoretically allowing less capsular contracture and a super thin extra layer of tissue coverage over the implant.  It still requires transaction of perforating blood vessels though which can be important in the future if a lift is required.  Therefore, each location has it's benefits and drawbacks.  If you could not tolerate the potential for implant distortion while working out, sub facial is reasonable. Hope this helps.