Hi, Dr Murray from Absolute Cosmetic here. Subfascial breast implants have had a real moment on social media lately, and I wanted to explain what’s actually going on, because a lot of what’s circulating on social media can be misleading.
What Are Subfascial Breast Implants?
Subfascial placement means the implant sits above the muscle but under the fascia, which is a thin layer of tissue that covers the muscle almost like glad wrap. In a subfascial placement breast implant surgery, you peel that layer up and put the implant underneath it, rather than sitting the implant directly against the breast tissue itself. It’s one of a few options for placing an implant above the muscle, alongside subglandular placement.
Why Are Subfascial Implants All Over Social Media Right Now?
They’re trending partly because it’s a technique that’s been used for many years in appropriately selected patients and partly because of a new tool overseas that allows you to inject the implant itself through a syringe-style device under the fascia. I think that injectable tool is what’s really driving the attention for subfascial breast implants; more than the actual placement itself.
It is important to know that the fascia can be quite challenging to peel up in some patients, and some people have a thin fascia to begin with, which makes it difficult to get the implant under it.Doing that with a syringe-like device – partially blindly – in the name of being less invasive, would be quite difficult I imagine.In my clinical view, this is a technically demanding step to get right, and it’s reasonable to ask how consistently it can be achieved with a less-open surgical approach, though I don’t have any data on how often that occurs in practice.
How Does Subfascial Compare to Dual Plane or Above-the-Muscle Placement?
Above-the-muscle placement, whether subglandular or subfascial, can be a great choice for the right patient, but it comes with two trade-offs worth knowing about. First, it doesn’t support the implant as well as placements involving the muscle, so breasts implants could drop more quickly with this approach. Second, it puts the implant closer to breast tissue, which carries a theoretical increased risk of capsular contracture, which is where the implant capsule tightens and goes hard.
Dual-plane placement works differently again. The pocket is created partly under the muscle and partly under the breast tissue, usually through an incision in the inframammary fold, which is the natural crease under the breast. Releasing the lower muscle attachments lets the muscle slide up and settle over the lower part of the implant, sometimes described as a window-shading effect, which gives support up top while still allowing natural lower pole fullness. In my clinical experience, dual-plane often offers a good balance of support and natural fullness for many patients, though subfascial and above-the-muscle placement may also suit other patients depending on their own anatomy and goals.
What Are the Risks, and How Do We Reduce Them?
The main risks with any above-the-muscle placement are quicker sagging over time and a theoretical increase in capsular contracture risk. We manage the potential risk of capsular contracture using strict non-touch technique and Keller funnels to minimise implant contact with skin – this is consistent with recognised infection-control practices. This does not eliminate the theoretical risk difference between placements, and individual results can vary.
How Do We Decide Which Placement Is Right for You?
It comes down to your anatomy, your tissue coverage, and what you’re trying to achieve. Subfascial can be a great option for the right patient. Above-the-muscle placement can be a good option for other patients too, particularly when supported by strict sterile theatre protocols. However, for most of my own patients, I find dual-plane offers a strong balance of support and natural fullness. This is a genuinely confusing topic even within the industry, so it’s worth talking it through properly at a consultation rather than making any decisions based on what’s trending online.
Frequently Asked Questions
What does subfascial mean in breast augmentation?
It means the implant is placed above the pectoral muscle but underneath the fascia (the thin connective tissue layer covering it), rather than sitting directly against the breast tissue.
Is subfascial the same as above-the-muscle placement?
Subfascial is one type of above-the-muscle placement. Subglandular, where the implant sits directly under the breast tissue with no fascia layer between, is another.
What is the injectable implant technique people are talking about online?
It’s a newer overseas device that inserts the implant through a syringe-style tool under the fascia, marketed as less invasive. In practice, cleanly lifting the fascia can be technically challenging, and it’s worth discussing with your surgeon how this may affect the reliability of the result.
Does subfascial placement increase the risk of capsular contracture?
There’s a theoretical increased risk because the implant sits closer to breast tissue. Strict sterile technique is used to help manage infection-related risk factors regardless of placement, though this doesn’t eliminate the theoretical difference between placements.
Is dual plane better than subfascial?
Dual plane can offer greater support and a natural lower pole result for many patients, though subfascial suits other anatomies well. The right choice depends on individual anatomy and goals, which is best discussed at consultation.
Who is a good candidate for subfascial breast implants?
Patients with enough natural breast tissue for coverage, a fascia that can be lifted cleanly, and goals suited to an above-the-muscle result tend to do well with this placement.
If this all feels a bit confusing, you’re not alone, it’s a genuinely nuanced topic. Come in for a consultation and we’ll talk through what options may suityour anatomy and goals. Visit absolutecosmetic.com.au to book.
This information is general in nature and does not replace personalised medical advice. Individual suitability and outcomes vary based on anatomy, health history and other factors. All surgery carries risks, and these should be discussed in full during your consultation with Dr Glenn Murray.
