Subpectoral Placement Vs. Subfascial Breast Implant Placement

Question

If a subpectoal placement of implant requires a cutting of the pectoral muscle, does this account for the warning that some surgeons give that the breast and nipple area can jump up 1 to 2 inches after a subpectoral placement, given that the muscle might contract upwards? Is there any comparative disadvantage to subpectoral placement (as compared with subfascial for example)?

Rian A. Maercks, MD · Answer

Subfascial placement in my hands is vastly superior to submuscular for the reasons that you mention and others.  With subpectoral placement there is always some degree of lateral displacement of the implants leaving them to rest in at best a less than natural position.  With every motion of the arms the tone in the pectoralis major muscle changes and usually leads to the implants being pushed down and out over time.  THe inferior pole is usually left in a subglandular position with no support ie dual-plane.  this is a perfect set up for bottoming out, strange shapes, and lateral(toward the armpit) displacement of the implants.  If you look at friends with subpectoral placement you will commonly see a large valley between the breasts that widens with excitement, animated expressions, phyical activity.  Have one of your friends put their hands on their hips and push down hard and you will see exactly what I am refering to.  Not only does subfascial placement avoid these direct forces, it actually buffers the pressure of the implant and the forces of gravity on the breast tissue.  

	 

	All the best,

	 

	Rian A. Maercks M.D.

Austin Hayes, MD · Answer

It's a great question. I strongly prefer under the muscle implants because the muscle provides another layer of camouflage for your implants. The muscle contours the top of the implant to give it a more natural slope and implants under the muscle have a decreased risk of scar tissue forming around the implant (capsular contracture). Although an implant on top of the muscle can be a good choice for some women, for very thin women there is not enough camouflage for the implant to look natural. When considering breast augmentation make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options, so that you can decide if breast augmentation is right for you.

Jed H. Horowitz, MD, FACS · Answer

Each are beneficial according to implant type and placement. 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.This #sub-glandular #placement may allow for a shorter surgery and recovery with 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.The #Dual-Plane 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.

Shahram Salemy, MD, FACS · Answer

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.

Richard Baxter, MD · Answer

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.

Francisco Canales, MD · Answer

Hello
All subpectoral implants will show some movement when you press the pectoralis muscle in certain ways.  Except for a very rare person, this process is not a concern to patients.  
However, if it is  important that your implants not cause any distortion of the nipple, then subglandular placement is an alternative.  I don't think that there is any difference between subglandular and subfascial placement, for practical purposes.
Make sure your surgeon is comfortable with both approaches and he/she can guide you in the best decision.  There is no risk-free surgery and each approach has its own set of possible problems. The more you know, the better decision you can make.

Leslie H. Stevens, MD, FACS · Answer

When a surgeon evaluates a patient for breast augmentation, it is important to make the right choice for implant placement. Someone who has plenty of breast and soft tissue in the upper hemisphere of the breast, going sub-glandular or sub-fascial is an appropriate choice. For someone with little tissue on the upper half of the breast, it is best to add another layer of coverage between the skin surface and the implant. That layer is the pectoral muscle. By doing so, one would avoid a potentially unnatural looking result and possible visible wrinkling in a area that is easily seen in a bathing suit or low cut dress or blouse.
True, there is a degree of the implant moving with muscle contraction, but this is rarely an issue with women who have sub pectoral implants. The trade off is worth it.
Sub-fascial has a greater morbidity with potentially more bleeding during the procedure. Sub glandular would be my recommendation if implants were to placed above the muscle.

George J. Beraka, MD (retired) · Answer

Hi!  Subpectoral implants will indeed move when you contract your chest muscles. You will not be happy.
The sub-fascial position has very few applications, in my opinion.  But it is an option.  For women like you, I use subglandular silicone implants (even on very thin women), and they do just fine.

Subpectoral Placement Vs. Subfascial Breast Implant Placement

Answers (8)

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