What is a subfascial breast augmentation?

Thanks so much for reaching out.   Subfascial implant is an implant that is placed over the muscle but under the thin fascia that covers the muscle.   Is said to decrease incidence of cancer contracture and may be beneficial to patient who do otherwise undergo sub glandular implants. 

 I hope this helps :-) 

Hi there, Thank you for your question. Subfascial breast augmentation, is when the implant is placed above the muscle but under the fascia that covers the muscle. Best, realdrsix

The fascia is a thin layer that covers the muscle (in this case, the pectorals major).  Some surgeons like to lift this layer and put the implant over the muscle, but under the fascia.  Effectively, the implant is under the breast and over the muscle in these cases, so for practical purposes, you could think of this as an "over the muscle" implant (or sub glandular).

Breast augmentation is often performed to replace volume lost from weight loss, breast-feeding, or age or to increase the size of the breast for aesthetic reasons. The implants are most often placed under the pectoralis muscle (sub muscular), partially under the muscle (dual plane), or over the pectoralis muscle (sub glandular). 
See the following link for more information on breast augmentation. Sub facial placement of an implant is much less common option that places the implant under the thin tissue that covers the surface of the pectoralis muscle. This placement may possibly add support to the implant pocket - decreasing the risk of bottoming out - and decreasing the risk of muscle flexion distortions (animation deformity).Sub facial placement is more commonly used overseas with form-stable implants.The sub facial space is not a naturally occurring plane, however, and so the dissection is more traumatic than other techniques - even with cautery. The shape is also more akin to the "done" look of a sub-glandular augmentation.

A detailed examination will help delineate the best surgical option. Consultation with a surgeon certified by the American Board of Plastic Surgery would be the next best step.

Hi there. Subfascial is a term to describe implant pockets that are just on top of the muscle (but under the thin sheet of tissue that separates the muscle from the breast tissue - the so called 'fascia'). If you're a patient who doesn't need the implant to be placed under the muscle (because either you have a reasonable volume of natural breast tissue or the skin cover is sufficiently thick at the top of the chest) - then a subfascial or sub glandular is appropriate. There is little to differentiate the two as it is just a subtle technical difference. But in my mind, the extra fascia cover in subfascial may confer some advantage and therefore all patients suitable for an 'over the muscle' approach in my practice undergo subfascial implant placement. And the recovery is the same. Good luck!

Hello and thank you for your question.  There are three planes for implant placement:  above the muscle, below the muscle, or above the muscle but below the fascia.  There are several advantages
and disadvantages to over vs under the muscle.  Under the muscle has the
advantage of lower capsular contracture rates, less risk of rippling, and
better visualization with future mammograms.  Most patients say that under
the muscle also has a more natural look and feel.  The size, shape,
and profile of the implant is based on your desired breast
size/shape, your chest wall measurements, and soft tissue quality. 
This decision should be based on a detailed discussion with
equal input from both you and your surgeon.  This entire surgery can be performed with a
small incision technique.  Make sure you specifically look at before
and after pictures of real patients who have had this surgery performed by your
surgeon and evaluate their results.   The
most important aspect is to find a surgeon you are comfortable with. I
recommend that you seek consultation with a qualified board-certified plastic
surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Breast augmentation is most often performed sub muscular, beneath the pectorals major muscle, because there is a lower incidence of hardening of the implants (capsular contracture), interfere less with mammography and is less palpable on the surface. On the other hand a subfascial is a little deeper then sub glandular placement is subject to less distortion with pectorals muscle movements, quicker recovery and less discomfort from surgery.

As the other surgeons have stated there are three planes essentially, to place the implant in. The subfascial plane was described by Dr Ruth Graf to reduce the incidence of capsular contracture and provide additional coverage for the implant. That the gland itself is protected and thereby less chance of colonization of the implant is potentially offered is a good reason to perform the additional step of lifting the fascia with a needle tip cautery. However, in my experience the pain post op is greater than performing the dissection a little higher leaving the fascia intact on the muscle. Hope this helps.

A subfascial pocket position is one that is right under the gland and just above the muscle.  In my opinion, this does not seem to offer any advantage over a subglandular pocket.

I have been doing breast augmentations for over 30 years --- in my experience I believe that this is a made up operation that does not exist. The fascial plane is over the muscle under it's fascia which is the most filmy whispy stuff. I don't believe the people who say they can put the implant there -- first of all the muscle almost never covers the lower third of the implant so what fascia is it under. This is not a real plane to put the implant in.