Subfacial Placement Vs Under/Over Muscle

I will have to respectfully, but completely disagree  with previous responses.  Subfascial breast augmentation is VERY misunderstood.  Few surgeons perform this technique and many of those that claim to are really performing subglandular placement and making it sound fancy with the subfascial name.  Unfortunately many of those offering subfascial breast augmentations actually have no training in plastic surgery. 

 

I perform EXCLUSIVELY subfascial placement with a unique technique that I developed called "Cold-Subfascial Breast Augmentation.TM"  Most surgeons performing subfascial breast augmentation use a hot electrocautery device which kills and vaporizes a varying degree of the fascia which is the most important structure in successful breast augmentation in my opinion.  By damaging the fascia the procedure really equates to subglandular placement.  Keep in mind every surgery is very different in every surgeon's hands no matter what they call it.  It is what they actually do, their attention to detail and their level of aesthetic astuteness. It is true that the fascia is 1-2mm thick but it is also true that it has incredible tensile strength and that the advantages have been well studied and published by Dr. Ruth Graf and others.  In fact two months ago in Plastic and Reconstructive Surgery, the seminal journal of our specialty, A Turkish group published a clinical study touting the vast advantages of the subfascial plane.

 

My opinion is that the muscle should NEVER be violated in breast augmentation.  If you involve the muscle (ie dual-plane or submuscular placement) you Will get muscle jumping called animation( implants jumping around with arm movement), widely splayed unnatural appearing breasts( because the medial origin of the pectoralis major must be left intact and pulls the implants to the sides) and a "down and out" bottomed out appearance with time (because the bottom of the implant is subglandular with no support and the top of the implant is continually pushed down and out by the pectoralis major muscle.  In a true subfascial breast augmentation, the entire implant is held and shaped by a strong natural internal support bra- your bodies own fascia.  There are many surgeons placing foreign bodies like Strattice in womens bodies in failed attempts to create this support in revisions.  I say do it right and structurally sound the first time without foreign bodies and higher complication risks.

 

As far as recovery goes, most of the pain and swelling after breast augmentation is due to the muscle cutting and dissection.  In my experience patients are back to their lives in 1-5 days.  I commonly have patients fly in for surgery and most of them enjoy it as a five day vacation in Miami.  Some are enjoying poolside relaxation the next day and out for nightlife the next night.  Some linger at home for 5-6 days but this is by far the exception. 

 

With Cold-Subfascial Breast Augmentation I deliver what I believe to be unparalleled results as far as natural appearance and aesthetic beauty that I personally could never deliver with dual-plane or submuscular.  You will not find widely splayed breasts that jump around or have a down and out result in Cold-Subfascial patients.  I commonly revise dual-plane breast augmentations to Cold-Subfascial in the first year after a primary surgery because patients are embarrased by what has in my practice earned the name "The Miami Valley," the wide empty space between the breasts that you can commonly fit the palm of a hand.

 

To summarize the most important part of your surgery is not what the surgery is called but rather what the surgeon actually does.  There are many well respected dual-plane surgeons with many happy patients, I just have a very different aesthetic ideal , I am focused more on a natural look and patients looking for that tend to find me.  Others are looking for an "augmented look" which I flatly refuse to deliver making such patients not appropriate for my practice.  I hope this helps!

 

 

All the best,

 

 

Rian A. Maercks M.D.

#Subpectoral or
#submuscular implants refer to placement under the muscle which still remains
the most common placement in the United States. #Submammary or #subglandular
implants are the placement under the breast tissue in front of the muscle.This tends to more common in Europe and South
America.General guidelines suggest that
women with larger drooping (ptosis) breasts that do not want a breast lift often
have the implant placed above the muscle, although another option,#DualPlane, has become more popular. In the
Dual Plane method, the implant is placed under the pectoralis muscle but the
breast tissue is also release, in part, from the muscle. Those patients with
minimal breast tissue should usually have the implant placed beneath the
pectoralis muscle for more soft tissue padding. In any case, your plastic
surgeon will determine which placement is best for you. When you come in for a
consultation, the different options will be explained in further detail.

The sub-fascial approach has been presented at the Plastic Surgery meetings over the last few years.  To me, it's hard to understand how effective a very thin (less than 1 mm) layer of collagen - the muscle fascia - is going to make a difference compared to subglandular placement of the implant.  


The science behind the subfascial technique, proving some long-term advantages, is just not there yet.  As such, I would not recommend it to you (or anyone else) at this time....not until better long-term data comes in.




 




Best wishes,

The pectoralis muscle is covered by a fascia, which is sort of fibrous sheet separating it from surrounding tissues. In the subfascial plane, the pectoralis muscle fascia is dissected off the underlying muscle and the implant can be placed in this plane.  However , this plane is very thin and I do not think it makes any difference from suglandular plane. I have not performed suglandular/subfascial breast azugmentation in 10 years. Not because I cannot do it (it is simpler than under the muscle ) but because submuscular plane have lots of advantages even in skinny girls. Firget about subfascual!…. 

Based on your pictures, you look like a good candidate for breast augmentation.  However, a in-person consultation / examination would be required.  If you are happy with the doctor and the results that you see in other patients, then go for it.  Don't try to make the surgeon do the surgery a different way than what they usually do.  If you do not want the sub-facial procedure then seek out a board certified plastic surgeon that does submuscular implants.  In my opinion, submuscular is the best placement in the majority of patients, but there are differing opinions.

 

Good Luck.

Absolutely you can have BEAUTIFUL breasts at 55!  Your breasts are actually quite nice, and will look great with implants.  I disagree that in 10 years you will have alot of sagging- depends on what technique you have.  If you have implants placed behind the muscle, you will have a good support mechanism for the weight of your implants, and a fuller, more youthful breast.  If you have sub-fascia or sub-glandular placement, you will still have a nice look (if you get silicone gel) but over time the weight of the implant may cause a lower breast/ more drooping over time.

The fascial overlying the pectoral muscles is thin. The plane between the fascia and muscle is vascular and bloody. Placing an implant subfascially does not make a lot of sense. I can understand why subglandular placement of an implant might be important to some patients. I just don't see why placing an implant behind a thin veil of fascia offers any advantage. Perhaps one of the surgeons on this forum can explain it to me. My advice is to keep a simple operation simple - place the implant behind the muscle if you have thin tissues, or on top of the muscle if you have thicker tissues. From your photos, you appear to be a good sub-glandular candidate. You don't need a breast lift- yet.

The use of the subfascial plane is common in Europe and South America but for some reason slow to catch on in the U.S. The fascia (rhymes with fashion) is thin but sturdy enough to add support. There aren't a lot of consumer-oriented resources but here are two scientific articles:

Baxter R. Subfascial Breast Augmentation: Theme and Variations.
Aesthetic Surgery Journal 25(5);447-53, 2005.
Hunstad JP, Webb LS. Subfascial Breast Augmentation: A Comprehensive Expreience. Aesthetic Plast Surg 2010 June;34(3):365-73.

It seems from the photos that you are a great candidate for breast augmentation. You have minimal sagging ( I would need to look at your breast profile as well). What you could benefit from is an implant that will give you volume in the upper part of your breast without being extremely large to weigh your breast down.
In my opinion from the photos, a subglandular / subpectoral gel implant would be a suitable choice for you. Good luck !

Probably more important than the specific procedure performed, will be selection of plastic surgeon. I would suggest that you spend most of your time/effort concentrating on careful selection of your plastic surgeon.I think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).The submuscular positioning also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.Best wishes.