Critics of the subfascial method are skeptical of how well this actually works, and whether it is worth the extra effort. But a recent study[i] from Brazilian plastic surgeon Ruth Graf finds a clear and lasting benefit to subfascial placement. I was especially happy to see this paper, because it was a presentation by Dr. Graf at an international plastic surgery meeting in Sydney Australia that got me started using the method almost 20 years ago. My own paper Subfascial breast augmentation: Theme and variations published in 2005 was the first on the technique in North America.

One of the variations is the split muscle plane, which I developed at the same time. This preserves the benefits of under muscle placement in the upper and medial (cleavage) area without the notorious animation deformities that can occur with dual plane. This is an important option because not every patient has enough “padding” of a fat layer under the skin to camouflage the edges of the implant. It is generally recommended that there is at least 1-1.5 cm (a little more than a half inch), determined with a simple pinch test. (A method called “composite breast augmentation” proposes to do fat grafting with subfascial placement in order to make it work for more patients.)

So subfascial is here to stay, especially as more and more patients show up with animation deformity from dual plane. I have performed well over a hundred cases of animation correction by converting from dual plane to subfascial or split muscle. (Examples here) It is equally gratifying to know that it can be prevented without compromising results.