Does subfascial breast augmentation sag over time? (Photo)

Question

I’m curious about subfascial breast augmentation but I’m worried about how it will look over time since it’s over the muscle and nervous about it sagging

Semih Yildiz, MD, FEPOBRAS · Answer

Subfascial breast augmentation can be a good option in selected patients, especially when there is enough natural soft-tissue coverage and the goal is a more natural look without placing the implant under the muscle. However, the subfascial plane does not stop the breast skin and gland from aging or stretching over time. Sagging depends more on skin quality, existing nipple position, breast tissue thickness, implant size and weight, pregnancy, weight changes, and genetics than on the pocket alone.

If the nipple already sits low or there is meaningful skin laxity, an implant alone can sometimes make the lower breast look heavier or create a waterfall-type appearance over time. In that situation, a lift, a smaller/lighter implant, or a different pocket may be discussed. The best choice requires an in-person exam with measurements of your breast base width, tissue thickness, nipple-to-fold relationship, and skin stretch before deciding between subfascial, dual-plane, or submuscular placement.

Gianfranco Frojo, MD · Answer

There are many issues that can happen with inadequate soft tissue coverage of the breast implant over time. The data also supports use of a submuscular pocket. I always recommend a properly done dual plane (submuscular pocket).

Chet Mays, MD · Answer

Thank you for your inquiry!  Because of gravity, everything will sag overtime with proper support.  Schedule a consult with a Board-Certified Plastic Surgeon to help you maximize your result time!

Brian K. Reedy, MD · Answer

Thanks for your question! We are all getting older and our bodies will continue to change with time. Your breasts will naturally get droopier, with or without implants. Sleeping in a bra and supporting your breasts will help over or under the muscle. Good luck!

Irena Karanetz, MD · Answer

Hello,
 
Thank you for the question.

Subfascial breast augmentation technique is safe, and may be associated with lower capsular contracture rates when compared to sublgandular breast augmentation.
 
In addition, placing the implants above the muscle (subglandular or subfascial plane) can help minimize animation deformity (when implants move during weightlifting).  However, not everyone is a candidate for above the muscle breast implant placement because if the breast tissue are very thin, implant rippling may be more pronounced in the upper pole of the breast.  In addition, if breast tissues are weak, bottoming out may be more pronounced with subfacial/subglandular plane when compared to submuscular plane.
 
Implant size discussion and implant selection is one of the most important steps during your consultation with plastic surgeon. The decision-making process depends on patient’s desires, as well as breast and soft tissue dimensions.
 
I would encourage you to seek a consultation with a Board-Certified Plastic Surgeon to further discuss your options, specific techniques, concerns and expectations.
 
I hope this helps.
Best regards, Dr. Karanetz

Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon
Queens, New York
(516) 833 0309

Azita Madjidi, MD, MS, FACS · Answer

Any breast augmentation can sag overtime but to a different degrees. The gravity and aging tissues will make the breasts sag but if the implant is held up by the muscle, then the breasts will sag over the implant. Not everyone has thick fascia to be able to use for augmentation but it is hard to predict until once in the surgery. If it is thin, it will tear and it will be like a subglandular augmentation.

Daniel Barrett, MD · Answer

Dear Easygoing303343,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gerald Minniti, MD, FACS · Answer

There is no good data to show that incidence of capsular contracture with subfascial placement is any different as subglandular. Case reports from individual surgeons does not make for valid data. In addition, fascia is a millimeter thick, and so does not provide any soft tissue coverage for the implant other than than the overlying breast tissue and fat. Many surgeons on social media love to show their patients results at 3 months. Let's seem some results at five years; in all likelihood they will look like subglandular implants with noticeable rippling and a visible step off in the upper chest. Your best bet is subpectoral placement regardless of how active you are.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. I have been in practice almost 30 years and breast revision surgery is a large portion of my practice. "Subfascial" IS subglandular. The fascia of the pec major muscle is wispy thin and has very little structure. I have a whole gallery titled "long-term changes associated with implants placed on top of the muscle ". I have seen so many patients who have had implants on top of the muscle and they all suffer from the same thing, slide down of the implant on the chest wall. There is nothing to prevent the implant from sliding down the chest wall. Best wishes to you.

Ram Kalus, MD, FACS · Answer

Thank you for your question. This reply is generic and not specific for you without photos or an examination in person. That said, the normal anatomy of the female breast is such that ALL breast tissue is ABOVE the muscle. Placing an implant under the muscle is an invention of plastic surgeons for various reasons that are necessitated by virtue of the limitations of existing breast implants. The most anatomically correct location for a breast implant is above the muscle. The skin of the breast will naturally stretch over time, and the effects of gravity and aging are inevitable. But the "sagging" of the breast will look more natural with an implant in the subfascial or sub glandular position than it would with a sub pectoral or dual plane, which would likely result in a "waterfall deformity" wherein the breast and nipple areola are "falling off" the higher positioned implant, which tends to stay put with its enclosing capsule.

Please consult with an experienced board certified plastic surgeon who can review with you all of your options. Best of luck.

Please consult with an experienced board certified plastic surgeon who can review with you all of your options. Best of luck.

Does subfascial breast augmentation sag over time? (Photo)

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