Subpectoral Placement Vs. Subfascial Breast Implant Placement

There are advantages and disadvantages with subglandular, subpectoral, and subfascial placement of implants, and you should have a thorough discussion with your surgeon about these options, including whether or not to use a saline or silicone implant.
In some patients, a subglandular placement of a silicone implant can give a very nice, attractive result, without the worry of the implant moving with contraction of the muscle. However, this option only works if there is enough tissue to cover or hide the implant, in particular at the top of the breast. Some surgeons feel the risk of capsular contracture is higher with this placement, and others see no difference, but it's important to understand the advantages and disadvantages of each option before proceding, and the best way to do this is through a discussion with your surgeon.

The subfascial procedure is often a good option to prevent the types of distortion that can occur with subpectoral placement, but there are some issues to consider. I first became interested in the procedure about 6 years ago when I heard a presentation by a south american plastic surgeon at a plastic surgery meeting in Sydney. The subfascial option is used mostly outside the U.S. and with form-stable implants (Allergan 410, Mentor CPG). Since we only had the round implants available in the U.S., I developed an alternative using a muscle-splitting approach so that there is muscle coverage for the upper pole of the implant, where it is most needed, but because the attachments aren't cut there is minimal distortion with muscle activity.