Discover the benefits of subfascial breast implants. This technique places breast implants in between a thin layer of breast tissue and the pectoralis major muscle, offering natural-looking results, reduced pain, and a lower risk of rippling.
Learn if this approach could be right for you.
What is Subfascial Implant Placement?
A subfascial placement is a surgical technique that places the breast implant beneath the pectoral fascia (a layer of tissue covering the breast muscle) and above the pectoralis major muscle. This placement provides natural-looking results and minimizes muscle movement. While this technique has been around for a long time, it gained popularity when Dr. Ruth Graf introduced it in Brazil in the early 2000s.
Here’s how it differs from other approaches:
- Subglandular: Breast implants are placed behind the breast tissue and on top of the pectoral muscles. While it’s a less complex surgery, it can cause visible implant edges or rippling, which is when folds in the breast implant show through the skin. Subfascial implant placement provides a natural-looking appearance.
- Submuscular: This implant is placed under the pectoral muscle. It can provide a natural-looking shape but could cause animation deformity, a condition that results in unnatural movement or distortion of the implants. Subfascial implant placement has a lower risk of this complication.
- Dual-plane: With this approach, a surgeon places the implant partially under the pectoralis major muscle and partially under the breast tissue. Dual-plane offers the benefits of subglandular and submuscular placements, resulting in a natural look and feel. However, it’s a complex surgery. Subfascial placement is easier and usually provides faster recovery for the patient.
The Advantages of Subfascial Implants
Subfascial implant placement offers the following advantages:
- Aesthetic Benefits: This placement provides a smoother upper breast slope, less rippling, and reduced edge visibility.
- Comfort and Movement: By placing the implants under the pectoral fascia, this technique minimizes the risk of animation deformity and decreases interference with pectoral muscle activity.
- Decreased Risk of Complications: This placement lowers rates of capsular contracture compared to subglandular placement.
- Faster Recovery: Subfascial implants offer a quicker recovery and less post-operative pain than submuscular placement.
Candidate Selection: Who Might Be Ideal?
Not everyone is a suitable candidate for subfascial implant placement. Ideal candidates are women who are active or sensitive to muscle distortion. Subfascial placement may be a good option for someone who needs moderate soft-tissue coverage.
Subfascial breast implants are not ideal for patients who need maximum protection over the implant. Patients who have very thin tissue may be better candidates for submuscular or dual-plane surgeries.
Surgical Technique Overview
Depending on your surgeon’s preference, the incisions can be made in a few places. The incision options for subfascial implants include:
- Inframammary: This incision is placed in the natural crease under the breast, which provides a less visible scar.
- Periareolar: Placed on the border of the areola, this scar can be well-concealed by the darker pigment in this area, but may decrease sensitivity.
- Axillary: With this option, the incision is placed inside the armpit, providing a location to conceal scarring easily.
After your surgeon makes the incisions, a subfascial pocket is created beneath the fascia layer. Your surgeon can then insert modern cohesive (gummy-bear) silicone implants, which are often used with internal scaffolds or fat grafting.
Comparison With Other Implant Planes
Here is how subfascial breast implant placement compares with alternative surgical techniques:
| Technique | Placement | Pros | Cons |
|---|---|---|---|
| Subglandular | Above muscle, below gland | Quick recovery, less pain | Higher rippling; capsular risk |
| Submuscular | Beneath muscle | More coverage; lower contracture risk | Animation, longer recovery |
| Dual-plane | Partial muscle coverage | Balanced appearance and coverage | Some animation; moderate recovery |
| Subfascial | Beneath fascia, above muscle | Smooth contour, less animation, faster recovery | May be visible in very thin patients |
Several studies have shown that subfascial placement is a superior option for thin or athletic patients, resulting in reduced pain and no animation deformity.
Potential Risks
As with any surgery, subfascial breast augmentation has the following potential risks:
- Edge Visibility or Rippling: Patients with minimal soft tissue may experience rippling or implant displacement. https://pmc.ncbi.nlm.nih.gov/articles/PMC7671235/
- Limited Long-Term Data: Subfascial implants have less data available than dual-plane. Early capsular contracture rates are approximately 1%. Capsular contracture is a condition where scar tissue hardens around the implant, causing pain and distortion.
Finding an experienced surgeon to perform your surgery can minimize your risks. Precise pocket dissection is required with this technique to avoid complications.
Patient Recovery
Many patients who have had a subfascial breast augmentation have reported:
- Less pain after surgery
- Faster return to workouts (sometimes within two weeks)
- Implants feel more natural with less sensory disconnect
Everyone recovers from surgery at a different pace. This timeline provides a general idea of what you can expect:
- First 24-48 Hours: Swelling, soreness, and tightness in the breasts are common, but pain medication can relieve these side effects. Your breasts will feel hard and will be in a higher position, but they will settle over time. During your initial stage of healing, you should avoid strenuous activities. You will also be placed in a surgical bra for support and stability. As long as you’re on pain medication, you will not be able to drive.
- Week 1: Pain and soreness should be noticeably reduced, and you can return to work if your job isn’t physically demanding. Light walking can prevent clots. At this point, you will follow up with your surgeon, who will assess how you are recovering and remove your stitches. If you’re off your pain medication, you may be able to drive again.
- Weeks 2-4: Swelling will continue to subside, and your breast implants will begin to settle. However, it will take several weeks before they fully settle into place. It’s usually safe to resume lighter exercises with your surgeon’s approval, but you should still avoid strenuous activities. At this stage of recovery, you may also be able to wear a comfortable sports bra instead of your post-surgical bra.
- Weeks 4-6: With your surgeon’s approval, you may be able to return to some more strenuous activities, including upper-body workouts. It’s safe to perform most normal activities.
- Week 6-3 Months: The “drop and fluff” phase occurs around this point. This is when the implants soften and drop into a natural position. After your swelling fully subsides and your implants fully settle, you will be able to see the final results. For most people, the 3 month-mark is when they can see the outcome.
During this time, it’s important to follow your surgeon’s instructions to heal as safely and smoothly as possible.
Choosing A Surgeon & Decision Tips
It’s important to choose a board-certified plastic surgeon who has been trained in the subfascial technique. They follow strict safety protocols, perform surgeries in accredited facilities, and have the expertise to deliver natural-looking results.
A board-certified plastic surgeon can also let you know if you’re an ideal candidate based on your health, lifestyle, and soft tissue thickness. A qualified surgeon can also recommend the best implant type and determine if you need fat grafting or scaffolds.
When you’re assessing if a surgeon is right for you, it’s best to consider their complication rates, explore their photo gallery, and learn their approach to incision placement.
Subfascial Breast Implants FAQs
Does subfascial placement affect breastfeeding or sensation?
Subfascial implant placement is less likely to affect breastfeeding or sensation than subglandular placement. Since subfacial implants go underneath the fascia, they are less likely to compress milk ducts. A temporary change in nipple sensation is common after breast augmentation. However, subfascial placement lowers the risk of losing this sensation and may even enhance it because it places less contact between the implant and nerve endings.
Can you combine subfascial implants with lifts or fat grafting?
Yes, subfascial implants can be combined with a breast lift or fat grafting. This approach is called augmentation mastopexy, which can enhance the position and size of your breasts.
What implant types work best?
The best implant type for you will fit your lifestyle and goals. Each implant has its advantages, and your surgeon can help you make a decision. Saline implants are filled with a sterile saltwater solution and have a firm feel. They’re the least expensive but more prone to rippling than other implants. Silicone and gummy bear implants are filled with silicone gel. While they’re both safe, durable, and feel natural, gummy bear implants are less likely to leak.
How long does it take for the final shape to settle?
It typically takes between 6 weeks and a few months for the final shape to settle. Your implant size, type, and placement will affect this process. Larger, heavier implants usually settle faster. Patients with better skin elasticity or developed chest muscles may have a longer settling period.
Discover if Subfascial Implants are Right for You
Subfascial implants offer a natural appearance, reduced pain, and fewer complications for suitable candidates. If you’re considering this type of implant placement, schedule a consultation with board-certified plastic surgeon Dr. Sergey Turin. He will evaluate your anatomy and goals and let you know if this procedure is right for you.
Call (480) 605-0683 today to schedule your personalized consultation at Koda Plastic Surgery.
