Is subfascial breast augmentation a common placement?

Subfascial placement is the only placement I use in my practice.  Placing implants under the muscle causes spreading of the implants laterally and inferiorly creating a plateau between the breasts that is a dead give away of an augmentation.  the muscle ends up pulling the superior pole down due to the baseline tome and does not enhance or bulk the superior pole at all in my opinion.  I use a technique that is called 'cold-subfascial augmentation'  that preserves the viability of this crucial structure and allows me to use low profile implants to create a tear drop shape with beautiful projection and superior pole slope.  I would strongly recommend conversion to a true subfascial plane to prevent accelerated aging of your subglandular placement and to obtain a more natural beautiful shape.  I hope this helps.

 

All the best,

 

Rian A. Maercks M.D.

Breast Implant Placement

Under the Muscle (sub-muscular) – When you hear the words “under the muscle” this actually means the breast implant is placed partially under the pectorals major muscle. Submuscular placement may be more uncomfortable the first few days following surgery due to the disruption of the muscle.  The possible benefits of submuscular placement are that it may result in less palpable implants, decreased risk of capsular contracture, and easier to image the breast with a mammogram. Under the muscle placement is recommend for women are are very thin with very little breast tissue. The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.



Over the Muscle (sub-glandular) –  Over the muscle means above the muscle and under the breast tissue. This placement may make your surgery and recovery shorter and you will likely have less discomfort. This placement can provide a slight “lift.” Sub-glandular placement can result in more palpable implants, increased risk of capsular contracture and more difficult imaging of the breast with mammogram. This placement is often recommended for those patients with mild breast sag, but do not want a breast lift (mastopexy) and for tubular breast deformity.



Dual-Plane - This placement method is a more current technique most often used when there is mild breast sag and the patient does not want a breast lift. The breast tissue and muscle are partially separated to allow the breast tissue to sit in a better position. Dual-plane can be discussed further during the consultation should breast sag be of concern.



For women with moderate to severe breast sag, a breast lift (mastopexy) may be recommended to ensure the best result and longest lasting result. Failing to have a breast lift when necessary will only lead to a less than ideal result leaving the patient unhappy and needing a revision surgery. A larger breast implant can help lift the breast, but the low hanging breast tissue will still be present causing a disconnect between the implant and breast tissue located at the bottom of the breast.

Hi and great questions.

There are three different types of implant placement: above the muscle, below the muscle, or a combination (know as a dual plane). The correct placement depends on your goals and the appearance of your breasts. You need to be examined in order to decide on the best placement for you. It sounds like you may have capsular contracture based on your current placement (sub-glandular), saline implants, firmness, and change in implant position. If you do have capsular contracture, then you will benefit from changing the position to sub-muscular and utilizing a textured silicone implant. “Sub-Fascial” placement is different way of saying sub-glandular. The technical answer is that the pectoral fascia and the posterior breast capsule are essentially a fused structure; therefore, a sub-fascial placement is a sub-glandular placement. It is simply fancy marketing/advertising. If you do have capsular contracture, then a sub-glandular (aka sub-fascial) placement will not be adequate treatment. I hope that helps. Best of Luck!

Pictures would be very helpful in this case.  However, If you have saline sub glandular implants, I would certainly think that, in most cases, switching to silicone gel implants alone will almost always improve the quality of the result.  If you are lacking upper pole fullness, a wider implant may provide this for you.  Subfascial placement is an excellent first-time sub glandular pocket option that I perform often.  However, if you already have a sub glandular pocket, you probably cannot switch to a subfascial pocket at this time because the tissue layer will likely be too thin.  Switching to a sub muscular pocket is advisable if you are seeing rippling or having trouble with capsules, but otherwise may not be necessary..  

Thank you for this great (and concerning) question regarding subfascial breast implant placement.

First, let's talk about what fascial tissue is. It's the thin and very fibrous connective tissue that surrounds muscle throughout the body, including the pectoral muscle in the chest. Fascial tissue helps bundle muscle groups, blood vessels and nerves. Anyone who has ever skinned a chicken has seen fascial tissue. It’s that thin and amazingly stubborn layer of grizzly membrane over the muscle and meat. Similarly, in human anatomy, muscle and fascia are bound together. Attempts to separate the fascia and tissue to introduce an implant would be traumatic and ultimately ineffective.

When I review medical literature on subfascial placement (and there is very little - another warning sign) the supporting photo documentation often shows a pectoral muscle incision. The bottom line: the FDA, professional surgical associations, implant manufacturers and the vast majority of information in implant literature do not even mention subfascial as a viable breast implant placement option. Buyer beware.

While every patient and surgery is unique, Mandeline, your concerns do suggest submuscular might be the optimum placement option. As always, seek out only an experienced, board-certified plastic surgeon who can best deliver on the outcome you desire. I urge you to think twice about subfascial recommendations. It’s more marketing buzz than it is good medicine.