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?
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!
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 5 Breast augmentation (Saline breast implants), Breast lift, Extended abdominoplasty before & afters: