Subfascial Breast Augmentation: A Systematic Review and Meta-Analysis of Capsular Contracture

Abstract

Background Subfascial breast augmentation is a technique originally developed to reduce the risks of capsular contracture while decreasing the postoperative pain associated with subpectoral augmentation. It was pioneered in Brazil by Dr. Graf and others, and recently this technique has gained interest in the aesthetic world. Objectives The goal of this study was to provide a systematic analysis of subfascial breast augmentation to assess the combined reported rates of capsular contracture, animation deformity and complications. Methods The PubMed, Embase, and Web of Science databases were searched for the use of the subfascial plane for breast augmentation. We included studies that reported on capsular contracture and other outcomes following subfascial breast augmentation. Results Through the initial search, 26 articles were identified. Of which, 22 were included in the final study. A total of 3743 patients were identified across these studies with a total number of 38 cases of capsular contracture representing a rate of 1.01% of capsular contracture. Several articles reported on demographics, perioperative and long-term complications, and outcomes with regards to the aesthetic outcome from the surgeon’s perspective. Several infections were reported representing a rate of 0.1%. Animation deformity was not reported, although rippling was occasionally reported as was malrotation, axillary banding, sensory deficit, and asymmetry. Subfascial breast augmentation appears to have a low complication rate and an extremely low rate of capsular contracture at approximately 1%. Conclusions Subfascial breast augmentation may provide the benefits of low rates of capsular contracture while avoiding the discomfort and future animation deformity of subpectoral augmentation. Level of Evidence: 4

Discussion: Subfascial versus Subglandular Breast Augmentation: A Randomized Prospective Evaluation Considering a 5-Year Follow-Up

“…The placement of the implant under the fascia would reduce the biofilm “contamination” of the implant and produce lower capsular contracture rates, which has been documented in many studies. 10,16,17 Whereas the surgeon evaluation in this study revealed minimal differences in breast consistency (i.e., capsular contracture) at 1 year postoperatively, there was a significant difference at 5 years, with no capsular contractures in the subfascial group and a 15.8 percent incidence of grade 3 or 4 capsules in the subglandular group. Magnetic resonance imaging evaluation also confirmed a more narrow base width in the subglandularly placed implants compared to subfascial implants at 5 years, consistent with the capsular contractures seen at that time.…”

The Reverse Dual Plane: A Novel Technique for Endoscopic Transaxillary Breast Augmentation

“… 3-5 Generally, the pinch thickness should be ≥20 mm; otherwise, implant palpability (especially in the lower pole) and ripples are common complaints. 5 By combining the subfascial and submuscular planes, our modified technique completely released the tension of the pectoral muscle with the least amount of submuscular dissection. A part of the elevated pectoral muscle is completely separated from the part left in situ, and the tension release is complete; thus, the degree of postoperative pain is significantly reduced and BAD is eliminated.…”

“… 2 , 16 , 17 However, patients have occasionally had some complaints such as postoperative pain, animation deformity, and palpability of implants. 2 , 4 , 5 , 18-20 The transaxillary endoscopic procedure still leaves plenty of room for improvement. Therefore, in this study, we introduce our novel reverse dual-plane axillary endoscopic breast technique and compare it with the more traditional transaxillary dual-plane technique for achieving patient satisfaction.…”

Clinical Practice Patterns and Evidence-Based Medicine in Primary Augmentation Mammoplasty: A 16-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery

“…38 The submuscular plane has been associated with better prosthesis concealment 39 (level of evidence: IV) and a lower rate of capsular contracture 40 (level of evidence: V) but remains limited by animation deformity. The subfascial plane has been associated with comparable aesthetics and a lower rate of capsular contracture while avoiding animation deformity [41][42][43] (level of evidence: IV, V, and IV, respectively). The subglandular plane involves an easier dissection, decreased pain, and no animation deformity, but is thought to have a higher risk of capsular contracture and implant visibility or rippling (level of evidence: V).…”