Anatomic and Physiologic Advantages of Totally Subfacial Breast Implants

Abstract

For the past 4 years, whenever it was possible to choose between the subglandular or the submuscular location for the implant pocket (in cases with no precise indication for the submuscular location), the authors have opted for the totally subfascial plane (subaponeurotic) to avoid the disadvantages of the other locations and to obtain additional benefits. The subfascial plane lies below the deep thoracic fascia, or deep aponeurosis, which is not only that of the pectoralis (the muscle connecting with the breast in its upper two-thirds only). The implant is placed completely beneath this fascia, which covers, in addition to the pectoralis major muscle, the serratus, the lateral oblique, and the rectus anterior muscles. This study included 100 women who had breast implanted in the subfascial (subaponeurotic) plane. Of these women, 63 were thin patients with little fatty tissue. Textured surface implants were used McGhan style 120 and 110. All procedures were approached through an inferior periareolar incision. Excellent coverage of the implant as well as natural shape and mobility was achieved for all patients. No rippling in the upper half was observed. Two patients had Baker grade 2 capsular contracture (2%). No seromas or infections were seen, and only once was a surgical exploration necessary for excess drainage volume (1%). In the immediate postoperative period, less edema was recorded and recovery was faster than with the other two procedures: submuscular and subglandular. When circumstances indicate a subglandular pocket, the subfascial plane would seem to be the logical place for mammary implants.

Transaxillary Subfascial Augmentation Mammaplasty with Anatomic Form-Stable Silicone Implants

“…10 As other investigators have observed, the fascia is a strong, distinct layer that can be easily identified on axillary approach. [22][23][24][25][26][27][28] This layer has a significant strength that becomes apparent during intraoperative manipulation, and when approximated, provides continuous fascial coverage over a round and anatomically shaped implant (Fig. 3).…”

“…3,4,10,41 Despite the reliability of the subglandular pocket, placing the silicone implant next to the glandular tissue may lead to an unsatisfactory result in terms of implant visibility, which is especially noticeable in thin patients with smaller breasts and soft-tissue coverage, whereby a sharp transition can be seen in the limits of the implant. [22][23][24][25][26][27][28] To improve aesthetic results, alternative surgical options for the implant pocket have been described. 3,4 Among these, the submuscular technique was first introduced to contribute optimal [17][18][19][20] ; however, the main drawbacks are implant distortion, morbidity, and postoperative pain.…”

“…9,11,12,14 An alternative implant pocket is gaining popularity because of the better postoperative recovery it provides compared with submuscular approaches and because it avoids distortion when the pectoral muscle is contracted. 10,[22][23][24][25][26][27][28][29] Introduced in the 1990s, the subfascial technique is helpful for creating a support structure for the upper pole of the implant, which avoids inferior displacement and palpation of the implant edges. 12,22,23 In addition, with the advent of the subfascial technique, the potential benefits of TBA to patients, such as axillary incision and shorter recovery time, have become clearer.…”

Colocación transpectoral superior de implantes mamarios: Relevancia técnica y anatómica

“…En su porción caudal, sin embargo la disección de la superficie del músculo pectoral resulta ser relativamente fácil (8,9), encontrando ramas perforantes de muy pequeño calibre. La infiltración anestésica subfascial o intramuscular, reduce considerablemente la contracción muscular por la acción del electrocauterio mientras se realiza la disección y además facilita la hemostasia de los vasos perforantes menores.…”

Capsular contracture in subfascial breast augmentation: recommendations and treatment

“…In subfascial breast augmentation, there had been reports of 0% to 2% of capsular contracture [1][2][3]8]. Graf et al mentioned a 2.3% of capsular contracture grade II in 263 patients that underwent subfascial breast augmentation [8].…”