In the ever-evolving landscape of cosmetic surgery, breast augmentation continues to be a top choice for women seeking enhanced aesthetics. Despite the increasing popularity of breast reductions, lifts, and implant removals, as well as the influence of body-shaping trends like Ozempic, breast augmentation remains one of the most sought-after procedures globally. According to the American Society of Plastic Surgeons, over 300,000 women in the U.S. opted for this enhancement in 2023 alone. This enduring popularity is driven by informed patients who are reshaping expectations and advocating for personalized outcomes. Throughout my career, I have been dedicated to advancing techniques in subfascial breast augmentation. I’ve developed the internal bra technique to enhance results, providing long-lasting support for breast lifts, reductions, and implants. In this blog, my goal is to help patients understand why this sophisticated approach continues to be beneficial for the nuanced preferences of modern patients.
Understanding Subfascial Breast Augmentation: A Modern Approach
Most patients (and most plastic surgeons) think of breast implants going either under or over the pectoral muscle. Under is the most common, and the dual plane method is considered standard by many. In actuality there are four planes for implant placement, and in my opinion dual plane may be the most problematic of them. New research confirms what I have thought for a long time: subfascial (pronounced like fashion, not facial) is here to stay.
Subfascial breast augmentation is a technique of placing the implant in front of the pectoral muscle, but there is more to it than that. The fascia is the thin but strong layer of tissue on the surface of the muscle. A space for the implant can be created on top of the fascia (behind the breast or subglandular), or the fascia can be lifted off of the muscle, remaining on the undersurface of the breast. The idea is that although the fascia is thin, it is strong enough to add a little bit of support and smooth the transitions from the chest into the implant. Creating that smooth transition is one of the benefits of under-muscle placement.
Does Subfascial Really Make a Difference?
Critics of the subfascial method are skeptical of how well this actually works and whether it is worth the extra effort. However, 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) areas without the notorious animation deformities that can occur with the dual planes. 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.
The Benefits of Choosing Subfascial Breast Augmentation
When it comes to enhancing the appearance of your breasts, subfascial breast augmentation offers several unique advantages. One of the standout benefits is the natural look and feel it provides. By placing the implant under the fascia, we achieve a smooth transition from the chest to the implant, enhancing the natural appearance and feel of the breasts.
Patients often appreciate the decreased discomfort and downtime associated with subfascial placement. Since the implant isn’t placed directly under the muscle, there’s typically less post-operative pain and a quicker recovery time. This approach also maintains the strength and function of the pectoral muscle, which is particularly beneficial for those who lead an active lifestyle.
The fascia, although thin, is strong enough to provide additional support and stability to the implant. This helps keep the implant in place, ensuring a more stable and enduring outcome. Plus, subfascial placement offers versatility in implant choice, allowing us to customize the size and shape to your specific goals.
Understanding Subfascial Breast Augmentation: A Modern Approach
When it comes to enhancing the appearance of your breasts, subfascial breast augmentation offers several unique advantages that I believe make it an excellent choice for many of my patients. Here’s a detailed look at what you can expect from the process.
Initial Consultation
Your journey begins with an in-depth consultation with me. We’ll discuss your aesthetic goals, medical history, and any concerns you might have. I’ll evaluate your breast tissue, skin elasticity, and body structure to determine if subfascial breast augmentation is the best option for you. This is also your opportunity to ask any questions and understand the procedure, risks, benefits, and expected outcomes thoroughly.
Personalized Treatment Plan
After our consultation, I will develop a personalized treatment plan tailored to your unique needs and goals. This plan will outline the size, shape, and type of implants that will be used and the specific approach for placing them subfascially. We’ll also cover pre-operative instructions and what to expect on the day of surgery.
Pre-Operative Preparation
In the weeks leading up to your surgery, you may need to undergo certain medical tests to ensure you’re in good health. You’ll receive specific instructions on how to prepare for the surgery, such as avoiding certain medications, quitting smoking, and arranging for post-surgery care.
The Procedure
On the day of the surgery, you’ll be given anesthesia to ensure you’re comfortable throughout the procedure. I’ll make a small incision, typically in the inframammary fold (the crease under your breast), around the areola, or in the armpit. Through this incision, I’ll create a space under the fascia, the thin but strong layer of tissue that covers the pectoral muscle.
I carefully place the implant in this subfascial pocket, ensuring it sits correctly and creates a smooth, natural transition from the chest to the breast. The incisions are closed with sutures, and the area is bandaged to support the newly augmented breasts.
Post-Operative Care
After the surgery, you’ll be taken to a recovery room, where you’ll be monitored as you wake up from anesthesia. I will provide detailed post-operative care instructions, including how to manage pain when to start gentle movements, and what activities to avoid. You’ll likely be advised to wear a supportive bra to help with swelling and support the healing tissues.
Recovery Period
The initial recovery period typically lasts about 1 to 2 weeks, during which you may experience swelling, bruising, and discomfort. These symptoms gradually subside, and you’ll be able to return to most normal activities within a few weeks. However, strenuous activities and heavy lifting should be avoided for at least 4 to 6 weeks.
Follow-up appointments will be scheduled to monitor your healing process and ensure everything is progressing well. Over the next few months, the swelling will continue to decrease, and the final shape and position of your implants will become more apparent.
Internal Bra Technique— How Does It Assist Subfacial Breast Implant Placement?
To further assist and elevate the results of subfascial breast implant placement, over 20 years ago, I developed the internal bra technique to provide long-lasting support for breast lifts, reductions, and implants. This innovation uses materials like GalaFlex Mesh to support breast tissue and implants and help them maintain their shape over time, functioning similarly to an external bra but placed inside the body.
The internal bra is particularly beneficial for subfascial breast implant placement. In this technique, the breast implant is positioned between the fascia—a thin sheath of connective tissue—and the chest muscle. The internal bra tightens the breast implant pocket, ensuring the implant stays in the correct position and doesn’t shift over time. This added support helps prevent issues like bottoming out (implants moving downward) or lateral displacement (implants shifting toward the armpit), providing a more stable and long-lasting result.
Learn More About Subfascial Breast Augmentation and Internal Bra Technique By Scheduling Your Consultation Today!
Thank you for taking the time to learn about subfascial breast augmentation. This modern approach offers numerous benefits, including a natural look and feel, reduced risk of complications, and a quicker recovery time. If you’re considering enhancing your breast aesthetics, I encourage you to explore the advantages of subfascial placement. Schedule a consultation today to take the first step towards a more confident you.
For more information on subfascial breast augmentations, check out this article by Allure here.
