What Is a Subfascial Breast Augmentation?

I currently have saline implants and I'm in the process of looking into having them exchanged because I don't like the appearance of them (breasts appear too far apart). My current implants are placed subglandular. I went on a consultation last week and was told my implants should be placed submuscular. However, I am not a fan of the high, tightly compressed appearance implants placed under the muscle have. I have looked into having my implants subfacial but I am not sure I understand the difference between subfacial and submuscular. It also seems like most doctors currently place implants submuscular. How does an implant placed subfacial differ from one placed submuscular? What are the pros and cons of each technique? 

ShiningStar

F, 43, New York

Consensus

  • A subfascial breast augmentation is one where the implants are placed above the muscle but beneath the fascia, the layer of connective tissue which covers the chest muscles.
  • Subfascial insertion produces very natural looking results and has some advantages to both submuscular and subglandular insertion techniques.
  • A subfascial insertion has a lower risk of capsular contracture than a subglandular insertion. Because it’s a deeper insertion, it also carries a lower risk of edge visibility.
  • A subfascial insertion carries a lower risk of implant displacement than a submuscular implant and, because the implants are located above the muscle, the procedure requires less recovery time.
  • Not all patients have sufficiently thick fascial tissue for the technique to be effective.

The consensus is based on 5 doctor replies to this question. For more details, scroll down to read them.


The fascia is a layer of connective tissue situated above the layer of muscle. A subfascial placement goes beneath the fascia, but above the pectoral muscle at a depth called the subfascial plane.

Subfascial implants have a few advantages over traditional subglandular and submuscular implants.

The recovery time for subfascial implants is generally shorter than it is with a submuscular approach and there is a lower risk of implant displacement. Subfascial breast implant placement also carries a lower risk of capsular contracture than a subglandular placement.

Subfascial placement isn't appropriate for all patients. If you don't have a sufficient amount of tissue to hide the implant edges, a submuscular approach may still be the best option.

I can't give you any specific advice as to whether a subfascial implant makes sense without a direct examination. My advice is to consult with a board-certified plastic surgeon who has experience with both submuscular and subfascial breast augmentation to determine which option makes the most sense for you.

Dr. Frederic Corbin has 1 Breast augmentation before & after:

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There are definitely some advantages to a subfascial breast augmentation, however, the technique isn’t suitable for all patients.

As you know, the two other surgical techniques for breast implant insertion are subglandular insertion and submuscular insertion. These are commonly referred to as over the muscle and under the muscle insertion.

An over the muscle insertion has a shorter recovery time but carries a higher risk of capsular contracture. Also, because there is less tissue above the implant in a subglandular implant, there’s a higher chance of unattractive edge visibility.

Submuscular breast augmentation does a much better job of hiding the edge of the implants and has a much lower incidence of capsular contracture. Two negatives of submuscular implant insertion are that they require a longer healing time and carry an increased risk of implant displacement.

By placing the implants in the soft tissue of the subfascial plane, we can achieve the best of both worlds: Common risks like edge visibility, capsular contracture, and implant displacement are all reduced.

The procedure isn't right for all breast types. My advice is to consult with an experienced cosmetic surgeon to discuss which procedure is most appropriate for your specific case.

Dr. Stephen T. Greenberg has 10 Breast augmentation (Silicone breast implants), Breast lift before & afters:

Breast augmentation (Silicone breast implants), Breast lift before image performed by Dr. Stephen GreenbergBreast augmentation (Silicone breast implants), Breast lift after image performed by Dr. Stephen GreenbergBreast augmentation (Silicone breast implants) before image performed by Dr. Stephen GreenbergBreast augmentation (Silicone breast implants) after image performed by Dr. Stephen GreenbergBreast augmentation (Silicone breast implants) before image performed by Dr. Stephen GreenbergBreast augmentation (Silicone breast implants) after image performed by Dr. Stephen GreenbergBreast augmentation before image performed by Dr. Stephen GreenbergBreast augmentation after image performed by Dr. Stephen Greenberg

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Implants in a subglandular position are decreasing in frequency as we learn more about capsular contracture. The main reason for placing implants submuscular/dual plane or subfascial is to reduce the risk of capsular contracture and possibly to lower infection risk. However, going under muscle does potentially result in what we call "animation phenomenon" where the contraction of the pectoralis major muscle (pecs) can move the implant. Subfascial may be a "best of both worlds" of lower capsule risk (not fully clear that subfascial is as good as subpectoral/dual plane for capsule risk) but reducing animation deformity. However, many patients don't really have a thick enough fascia to develop a plane between the fascia and the muscle (so I believe a lot of surgeons claiming "subfascial" approach are actually just doing a subglandular one) and you may not be able to have particularly large implants put under the fascia depending on your anatomy.

I disagree with your assessment of a tightly compressed appearance of implants under the muscle - once things relax and settle it is often difficult for even experienced plastic surgeons to tell whether a patient had previous implants under or over the muscle without imaging studies. It all depends on technique, patient anatomy, surgical skill, healing issues, etc.

Feel free to reach out for more information. Good luck in your process!

Dr. Tim Sayed has 9 Breast Augmentation before & afters:

Breast Augmentation before image performed by Dr. Tim SayedBreast Augmentation after image performed by Dr. Tim SayedBreast Augmentation before image performed by Dr. Tim SayedBreast Augmentation after image performed by Dr. Tim SayedBreast Augmentation before image performed by Dr. Tim SayedBreast Augmentation after image performed by Dr. Tim SayedBreast Augmentation before image performed by Dr. Tim SayedBreast Augmentation after image performed by Dr. Tim Sayed

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Hi-

  Excellent question. Sub-fascial implant placement is similar to subglandular implant placement with an extra layer of tissue (fascia) coverage over the implant. The benefit is that you don't have to release the muscle so the recovery is generally easier and avoid the potenital animation deformities that can arise from sub-muscular implant placement. The negative of sub-fascial implant placment may be similar to subglandular downsides is less soft tissue coverage over the implant making it more visible. However in your case if you were happy with your sub-glandular implants than this is not an issue. Submuscular placement provides a very nice upper pole slope to the breast with the muscle draping over the implant with the increased soft tissue coverage. Hope this was helpful, good luck! 

The "Dual" plane placement is the newest technique to avoid sub muscular approach but better than sub glandular. Best to local a boarded PS doing Dual Plane implant placements. Not many are. Good Luck Regards Dr B, Miami 

Dr. Darryl Blinski has 1 Breast Augmentation before & after:

Breast Augmentation before image performed by Dr. Darryl BlinskiBreast Augmentation after image performed by Dr. Darryl Blinski

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