Sub-fascial Breast Augmentation: A new method of breast augmentation
Breast augmentation is a way for women to achieve breast fullness and a slight lift. It is a very personal choice in terms of size and shape of the breast augmentation that a woman desires.
During a breast augmentation consultation with a board certified plastic surgeon, there are many factors that will be discussed to give you the desired results such as size and shape of the implants, the location of the surgical incision, and most importantly which plane of tissue the implant will be placed in order to give the best and long lasting aesthetic results.
Breast augmentation with a silicone implant was first introduced by Drs. Cronin and Gerow in 1962. In the described procedure, the implant was placed in a sub-mammary space, or below the breast tissue. The sub-mammary placement of implant was popular secondary to technical ease. However, clinical evidences over the years have shown the sub-mammary plane have several problems such as implant edge visibility, higher incidence of capsular contracture, and implant ptosis over time. The implant ptosis occur in part due to disruption of connective fibers of the deep investing fascia surround the breast tissue which connects to the pectoralis fascia. In 1968, Drs. Dempsey and Latham described sub-pectoral implant placement whereby the implant is placed under the pectoralis major muscle. Subpectoral implant placement has observed lower capsular contracture rate, less implant edge visibility, and longer longevity of the breast shape or less breast ptosis. However, it has its disadvantages such as displacement of the implant to the superior pole and dynamic deformity with animation of the pectoralis major.
In 2000, Dr. Tebbets introduced dual plane implant pocket implant technique whereby the implant pocket allows for varying degrees of submuscular and subglandular coverage depending on the patient’s body habitus. The dual-plane pocket provides less implant visibility, longer shape durability, and less superior pole migration. However, dynamic animation deformity and flattening effect of the muscle is still bothersome for most patients. However, I questioned the shape durability of subpectoral breast augmentation. I have observed glandular ptosis below a subpectoral implant in patient with mild capsular contracture. This often results in an unattractive long appearing breast shape over a round implant below.
A new implant placement was described in 1998 by Dr. Graf who started placing implant below the pectoralis major fascia which is a layer above the muscle that separates the muscle from the glandular tissue. Subfascial implant placement carries many benefits such as preserving breast shape and prevent implant ptosis. This happens because the breast ligament attachment to the fascia is preserved and thus the breast shape is maintain over time and implant ptosis is prevented. Furthermore, it has less capsular contracture rate compare with subglandular pocket. Subfascial pocket provides a natural breast shape and unlike the subpectoral pocket, the subfascial pocket does not have the animation deformity with movement of the arms. It is the ideal pocket for most patients accept the extremely thin patients.
Therefore, subfascial breast augmentation is my choice for breast augmentation. It provides a natural long lasting breast shape without the animation deformity. Furthermore, it also has lower rate of capsular contracture.
(saline versus silicone), round versus shaped implants, smooth versus texture implants.