Torn between Subfascial and Dual-Plane BA. Which should I choose? (photo)

Question

After Breastfeeding & weight loss my breast look slightly deflated.I'm missing volume on the upper pole.I don't want big breasts,I want fullness. Nice Round Breast.I'm considering something around 250cc, round textured silicone implants.The only thing holding me up is,I can't decide between subfascial & Dual-Plane placement,since I do crossfit.Having my muscle cut & lose strength scares me.I want great results & no more hanging boobs.I'm afraid subfascial placement will make them hang over time.

Gerald Minniti, MD, FACS · Answer

Hello,You should know that the concept of 'subfascial' is more theoretical than substantial in its difference from subglandular.  It is really no different anatomically from subglandular, and the fascia, even if was important to make a difference from subglandular, is unlikely going to remain intact as a definitive layer after placement of the implants.  Most importantly, it does not enjoy the lowest risk of capsular contracture or tissue coverage as subpectoral placement.You worry about how your Crossfit will be affected, but forget that your risk of reoperation is higher with implants placed over the muscle. You will not always be doing Crossfit, but you'll likely have implants for the rest of your life.Just as an aside, the same decision making process should be applied to your incisions.  Periareolar incisions carry the highest risk of capsular contracture, and inframammary the lowest.  In Southern California, there is a unique trend to place implants through the periareolar incision despite the evidence of worse outcome. Best of luck!

Jose M. Soler-Baillo, MD, MS · Answer

Thank you for your question and photo.  I recommend that you consider the dual plane method over subfascial.  I tell my patients (even the most active ones) that this is the more ideal placement, and that they will need to treat their post-op journey like a pulled muscle.  There will be pain and discomfort at first, but this will subside with time and you can return to your active lifestyle.All the best,Dr. ResultsMiami, FL

Sheila S. Nazarian, MD · Answer

As you know, there are advantages and disadvantages to both types of implant placement. Really, the final decision is going to be up to you. Only you can decide what's right for your lifestyle. Best, Dr. Nazarian

Ahmad N. Saad, MD, FACS · Answer

Achieving your desired outcome depends on many factors, including choosing the implant size, shape, surface texturing, content, pocket plane, your body habitus and your surgeon.I can give you general guidelines, but in person physical exam is essential.I usually like to preserve the muscle in very active patients. Placing the implant in a subfascial plane is a great option for the right candidate, I use that plane in patients with enough skin/breast envelope to cover the implant. I hope that was helpful

York Jay Yates, MD · Answer

We all have our own experiences and aesthetic ideals, which sculpt our practice patterns.  In my opinion, basically every patient  is a good candidate for submuscular implants but subfascial requires careful consideration and selection.  A good candidate for subfascial (OR subglandular) augmentation 1) has enough breast tissue to cover the implant, particularly in the upper pole.  2) Desires small implants so there is less stress over time on the tissue, and 3) desires tear drop shaped implants for a less noticeable edge to the top of the implant.  #3 is less important in the patient with ample upper breast coverage and many PS's have no issue with round implants in the SG or SF pocket.  In your case, heavy exercise is the most compelling reason to consider going subfascial and it looks like you are a good candidate.

John Michael Thomassen, MD · Answer

I would recommend the textured implant in the subglandular/fascial position.  Since you are very active and do cross fit, the submuscular option may result in dynamic deformities that you may not be happy with.  The textured implant should limit the incidence of capsular contracture.

Aldo Guerra, MD · Answer

Hello and thanks for sharing your concerns. You also need to consider you're choosing a rather small breast implant and therefore if you go under the muscle a smaller implant is less likely to affect your muscle strength. Additionally, please wight the fact that under muscle seems to do better over time than above the muscle surgery. Subfascial is above the muscle surgery. I understand your predicament in choosing, but you need to seek guidance from your plastic surgeon about the best approach. Best wishes always, Dr. ALDO

Curtis Wong, MD · Answer

as subfascial is really over the muscle and I would speculate that those subfascial augmentations are not truly 100% subfascial.  So you have to decide if over the muscle is better for you or not?  And can you handle the muscle distortion that occurs when you have it under the muscle?

Richard J. Brown, MD · Answer

Lots of good questions here. Firstly, I crossfit as well and
have done several breast augmentations on my fellow cross fitters under the
muscle and they are all fine doing pull ups and all the other stuff we do. Sure
early on you have to take it easy and it does take time to get try strength
back but the pectoralis muscle still will work. So above or  below the
muscle is really a choice that should be made by weighing the pros and cons. I
have no idea how your surgeon described it at your consult. Honestly I reserve
above the muscle pretty much only for body builders. I mean real female body
builders who lift heavy and a lot. The reason is at shows when they flex their
pecs and the implant is under the muscle it moves around and looks odd. So for
them above the muscle is better to avoid animation deformity. The risk is the
tissue is thinned over time and rippling becomes more of an issue. Below the
muscle rippling is seen less overall, but still can occur. Aside from all of
this, if you are getting that small of an implant and have pretty lose skin be
very sure you do not need a lift rather than a dual plane. Dual place can be
great for patients who are borderline needing a lift, and will tolerate a
little more " hanging of the breast", but still look nice, compared
to a really "tight ball" appearance of the breast. What I mean by
"tight ball" is a higher tighter breast, which can not always be
accomplished with a dual plane. Do your homework on that procedure and be very
clear about what you want. Even if it is a small lift, lots of times when I
really get out of the patient what they are looking for, the lift is needed
more so than the dual plane. I say all of this having never seen or examined
you so take this with a grain of salt. Use this information more to make sure
you have thought this through and been very clear with your surgeon.

Michael M. Omidi, MD, FACS · Answer

Thank you for the question and photo. The choosing of
implants is a very crucial and is one that should be done through an in-person
exam. There are advantages and disadvantages with subglandular, subpectoral, and subfascial placement of implants, and you should have a thorough discussion with your board-certified plastic surgeon. Various aspects could affect the method of surgery and the choice of implants like breast tissue, body measurements, desired end result and the like.It is always best to
visit a board-certified plastic surgeon and have a full evaluation for your
concern. Best of luck. Dr. Michael Omidi.

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