Fashionably Subfascial: a (Not So) New Option for Breast Implants

We may feel like we are ahead of the curve in terms of innovation here in America, but an option for breast augmentation that has been popular for years in places from South America to Canada is just now starting to catch on here. The procedure, called subfascial placement (pronounced like fashion, not facial), is a versatile alternative that balances often competing factors between going over or under the muscle. I first heard about it several years ago at a meeting of the International Society for Aesthetic Plastic Surgery, and found it useful in certain situations. I published the first article on the procedure in North America in 2005 and have been using variations of it routinely. Now others are starting to see the benefits of going subfascial and it is starting to gain popularity.

The most common implant placement remains under the muscle (submuscular, subpectoral, dual-plane) because of the need for better implant coverage in many patients. If the thickness of the skin and fat layer is too thin, then the upper part of the implant shows through and the transition from the chest into the breast isn’t as natural in appearance when going over the muscle (subglandular). But going under poses certain problems such as animation deformities, which are distortions of the breast with muscle flexion. Subfascial strikes a balance between coverage, implant support, and function.

The fascia is a thin but reasonably tough layer on the surface of muscles, consisting of connective tissue that makes the compartments that contain muscles. By carefully lifting the fascia off of the pectoral muscle, a space for the implant can be created that leaves the muscle intact. While not adding padding, the fascia is often enough to smooth the transitions around the implants and add support. This is particularly advantageous for athletic women and body builders. It is not ideal for every case, but as more plastic surgeons discover the benefits of using the subfascial plane, I expect to hear a lot more discussion about it and it should become a standard option discussed with patients alongside submuscular, split submuscular, and subglandular.

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