Subfascial Implant Placement Risks?

I agree with the previous surgeon's response.  Although I am a huge proponent of subfascial placement of breast implants and taking extra steps to preserve this fascia in my 'cold-subfascial technique the surgeon is the most important piece of the puzzle.  If the surgery is not executed well then it really doesnt matter what you call it.  For example there are practitioners that use terms such as subfascial as a marketing ploy and either destroy the fascia with dissection technique or electrocautery ar just ignore the fascia completely, delivering a subglandular placement.  A well trained, technically gifted plastic surgeon with grounded judgement should be able to deliver excellent results with any technique they are comfortable.  Although I do believe subfascial placement is the ideal technique and has greatly reduced risks of all complications that you mention, certainly a patient is in better hands with an excellent surgeon and conventional techniques then a poor surgeon with advanced techniques.  

 

All the best,

 

Rian A. Maercks M.D.

 

All the best,

 

Rian A. Maercks M.D.

Sub-muscular implant placement is almost always the best choice. The muscle is most important as it provides an additional layer between the implant in the upper breast area. It camouflages any rippling that may occur and provides another plane to make it easier for mammography. Submuscular placment also lowers capsular contracture rates. Subfascial placement is more marketing buzz than sound medicine. Good luck to you. 

The Fascia can be a delicate structure which can be difficult to raise intact.
Commonly, when we perform breast reconstruction surgery after a mastectomy, the facscia is destroyed and we need to reuild it. This is one of the most commonly performed breast reconstruction technique. However, we continue to place the implant under the muscle, but reconstruct the fascia over the lower half of the breast, where it is particularly thin.
In augmentation patients, the fascia also becomes this over the lower and outer portions of the breast and technically, the pectoralis fascia is discreet from the serratus fascia.
The muscle is a clearly definable large anatomic structure whereas the fascia is less defined.
Similar discussions are held with buttock implants due to the size fo the gluteus muscles. However, repeated pistoning of an implant with exercise or activity can thin the fascia in this location.
Because the Subfascial implant placement is not widely practiced, it is difficult to draw any meaningful data from research published to date.
According to my references, approximately 80% of surgeons place their implants under the muscle.
Due to the tenuous nature of the fascia, I see it as a better alternative to subglandular placement, but generally believe the submuscular position offers best option. It is also important to note that is the position generally preferred by radiologists when interpreting mammograms as it results in the least distortion or obstructed visualization of the breast tissue.

Your question is a very good one. The subfascial technique is something I have been doing for 6 years and more than 400 cases. It is still uncommon in the U.S. but widely used in South America, Canada, and other countries.
The fascia is a thin but tough layer on the surface of the muscle, so it can be used for support of the implant but it isn't thick enough to add "padding". There are some variations that help with this while still correcting the distortion that occurs with muscle activity. If you like, I can send you a copy of my article on the subject.
Capsular contracture occurs in the same percentage of cases as under the muscle in my experience, and problems of malposition such as bottoming out are actually less common because one of the causes of that is the muscle pushing the implants down when they are under. I have had no cases of symmastia with the subfascial technique.
Please contact me if you would like a copy of the article or have any other questions.

I am doing subfascial breast
augmentation in most cases since 1999.Subfascial breast augmentation
actually leads to optimal results especially in women more than AA and B
cup size and when we select the most suitable size of implant under a
meticulous hemostasis and creating the right size pocket under the fascia with a long and thin cautery no-touching  the breast tissue.We are able to work with two types of implants
cohesive I and II Mentor,USA (no finacial benefits) according to breast
elasticity and the breast tissue amount .We have
achieved a very good  and long lasting results and our capsular
contracture rate is very low.This type of breast implant placement does
not create any bottoming out and or any distortion.In terms of the results i
do believe that create the most natural appearance of the new breast either when someone
touch the breast or the way the breast look under the bra.