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Less controversy over Submuscular vs Subfacial Implant placement at ASAPS Meeting (above vs below)


I have previously blogged in this controversy, and here is an update. The American Society of Aesthetic Plastic Surgery (ASAPS) hosted a debate at their annual meeting earlier this month (April ’16) . Respected plastic surgeons were asked if they used SM or SF implant positions and support their position in a debate. 

About 3 years ago ASAPS members were polled and 75% used SM and 25% used SF.  Dr Patric Maxwell from Nashville defended SM, and Drs Frank Lista from Canada and Ruth Grap from São Paulo, Brazil prefer SF. Patrick Maxwell argued that SM benefited from lower CC rates with aesthetically reasonable results, while Lista and Grap countered with much newer data where CC rates were actually lower, but aesthetic results were superior. 

ASAPS members were polled again, now the results are 50-50. Must Votes for SM were from the US while most SF were from South-America and Europa. The most switched votes were from the US now 60-40 for SM. (Previously 90-10)

In my own practice we use SF in 85% of the cases with a long term CC rate now near 2.5% similar to the rates reported by Lista and Grap.  


The Takeaway: more and more US surgeons agree with their S American and European  colleagues that SM placement is appropriate only in a minority of the augmentation population.

Glossary : 

CC; capsular contracture is a tight scar surrounding the  implant making the breast too firm.

SM: below the muscle placement includes “dual plane” surgery

SF: below the fascia (above) the muscle placement 

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Dr. Max Gouverne

Dr. Max Gouverne is a board-certified plastic surgeon in Corpus Christi with more than 20 years of practical experience. Paired with his approachable personality, his advanced knowledge and employment of leading-edge techniques ensure your utmost safety, comfort, and satisfaction.

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Dr. Max Gouverne, MD
Cosmetic Surgery

5642 Esplanade Drive
Corpus Christi, TX 78414

Phone (361) 993-2222 Monday–Thursday:
8 a.m.–5 p.m.
Friday: 8 a.m.–12 p.m.