Submuscular or subfascial for an active person? I'm 5'4, 130 lbs, and 32 AA.

Despite a vocal minority, subfascial has not exhibited any different clinical outcome than subglandular placement; higher rates of capsular contracture, unpredictable tissue stretch, and prominent rippling in the medial and upper regions of the breast/chest. Although you are active, subpectoral placement of implants has the best benefit to risk ratio. The most common problems specific to subpectoral placement is dynamic motion or deformity and double bubble, both of which are actually related to inappropriately large implant placement. When sized correctly, the vast majority of active women have enjoyed their breast implants without a hitch.

Hi. Similar to some of the other comments I basically consider there to be 2 choices. One is under the muscle (or dual plane, which means mainly under the muscle but partly under the breast gland itself). The other choice is subglandular which is under the breast gland itself. To me a subfascial placement is more of a marketing gimmick, no offense to those who push that. But the fascia on the chest muscle is typically thinner than a tissue. So the idea of there being truly a difference between trying to put it under this layer (and considering that layer to truly either be intact or not) or above that layer, I think it is not likely to be a situation where there really is any difference between above or below the fascia. In your situation with a very active lifestyle etc., it really can be a bit of a rock and a hard place decision. Above the muscle can be helpful to avoid the pectoral animation deformity may see when doing weight lifting etc. But at your stated height weight in breast size you likely have very little tissue there to camouflage an implant that is above the muscle so it may be something where you are not happy with the appearance because of that.
Good luck and take care,
Dr. Howell

Dear Helpful492025,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I have never understood this concept if subfascisl placement. The fascia if the chest muscle is so thin that it hardly even exists at all. I agree with submuscular placement.

Hello!
Placement really depends on your starting size and your goal size. If there is a significant difference in your baseline breast size and the implant you choose, then I do agree that under the muscle is the best way to go for the long term. Above the muscle, even subfascial, can tend to look "done" and not natural. The implant may also exacerbate sagging of your breast in the future. Subfascial really does not provide much support or camouflage. I have body builders in my practice who have done really well with under the muscle augment.
Best of luck to you!

Thank you for sharing your question. Based on your AA measurement I would still advocate for a sub muscular placement due to the lack of sufficient soft tissue coverage for your implants. You will still be able to maintain a healthy and active lifestyle. Hope this helps.

As a bodybuilder, I augment professional athletes frequently. I think for those people in whom the living is made by athletic performance, the implant can be placed above the muscle. Other patients will be happier longterm with submuscular (dual plane) placement.

Thank you for your question. Judging from your activities and present breast size, I would recommend smooth, gel implants in the submuscular position. This will give you a more natural appearance and lower incidence of encapsulation. I would keep the implants the smallest size that would make you happy. Typically there is a range of sizes that would work for you.

Pectoral exercises will increase the incidence of encapsulation regardless of the implant position. This has been my observation after performing the procedure for over 4 decades. If you do the pectoralis exercises, keep the lactic acid down, so don't go for the burn.

Again, thank you for your interesting question, and best of luck to you.

Since you have very little tissue to cover and hide the implants, I recommend going behind the muscle. However, choose the surgeon that you were most comfortable with and showed photos of women similar to your size.

There are 4 basic questions that need to be answered before breast implant surgery:

1. Location of scar (incision)
2. Above or below the muscle
3. Type of implant (saline/silicone, round, anatomic, high profile)
4. Size of implant

The hardest decision to make, BY FAR, is the size and style of the implants. Choosing implants based on projected bra size is a poor way to choose the size of the implant. The choice should be made based on the look that you want and then you can find a bra to match. It is not about bra size, it is about breast appearance.

There are advantages and disadvantages to both below and above the muscle. If you are thin and do not have much breast tissue, then I would choose below the muscle. If you have loose skin or some droopiness, then above the muscle might be a better choice. There is no right or wrong choice.

Please consult with a Board Certified Plastic Surgeon who performs breast enhancement surgery frequently to assure the best possible result.