This technique was first described in 2003 by an innovative female plastic surgeon from Brazil. It is a fabulous improvement over the now obsolete sub glandular method. This technically challenging operation is slowly gaining in popularity, as plastic surgeons in the U.S. are learning this new technique. This more modern method give superior results in properly selected patients. I recommend the sub-fascial for the following indications.
1. Best choice in a wider placed breast with a wide sternal gap
This is by far the most common reason for a compromised aesthetic result when the older sub muscular method is used. The sub-fascial method allows for a reduction of the widely separated breasts. I use this method to achieve a superior décolletage which so many patients now specifically request.
2. Best choice when there is a premium placed on aesthetic results
Superior results can be consistently obtained when the highest objective are aesthetics. A full youthful breast with a superior décolletage and excellent tactile realism make for a very happy patient. This superior degree of natural feel requires a higher performing gel implant.
3. Best choice when a rapid recovery is required
There is a significant improvement over traditional sub-muscular augmentation ( here the recovery is painful, requiring heavy doses of narcotics, delayed return to work, gym and a significant delay for a reasonable aesthetic result. Our recommendation of the added in-dwelling pain pump will allow for an ultra-rapid recovery. Most patients reports minimal pain (0-3 pain pills) and many take no narcotics. A rapid return to the gym is encouraged and most patients return to work in a few days. But the most significant improvement is the quick interval between surgery and optimal aesthetics (usually a week, rather than at least three months)
4. Best choice for athletes (or any low BMI candidate)
By far the most challenging augmentation patient is the low body weight athletic woman with minimal breast but significant needs. She requires a rapid return to the gym and minimal time for the new breast to look abnormal. Too much time away from training results in too much loss of hard earned performance gains. Prior to the more modern surgery these patients frequently had prolonged recovery and loss of power in their shoulder girdle and poor aesthetics as the mobilized pecteralis muscle distorts the breast with any arm motion. This was devastating for body-builders, models and fitness competitors. Now this challenging subgroup can return to training rapidly without loss of hard gained fitness and still have superior aesthetics.
5. Best choice for larger implants
A minority of patients desire a more showy augmentation (upper 30th percentile in size) this group places a premium on their new breasts’ appearance and the sub fascial method is superior in delivering a more curvaceous result . The traditional techniques cannot replicate this, and the patient will be disappointed with the result she desired and hoped to show off.
Pro’s & Con’s for sub-fascial breast augmentation
-Good for thin patients
-Quickly looks good (week)
-Better for showy augmentation
-Poor choice for saline implants
-A minority ( but improving) of surgeons have sufficient experience
-Can look bad if poorly executed (experienced surgeon a must)