Subfascial Breast Implant Placement Overview

With the advances in plasticsurgery, there are many available surgical techniques in breast augmentation to accommodate a specific anatomical feature, achieve the goals and expectations of a patient, create the most natural result possible, and minimize the risk of complications.

Nowadays, there are many breast implant placement techniques available to patients, although the most popular are the submuscular (the device is placed behind the muscles) and subglandular (the device is placed behind the tissues).

Meanwhile, there is a new technique called subfascial breast implant placement which is a compromise between submuscular and subglandular methods; it combines the benefits of the two primary placement options while eliminating the disadvantages associated with them.

The subfascial technique greatly resembles the subglandularimplant placement, with one major difference.  While the pectoral muscle is not touched, the fibrous fascia tissue is dissected from its front wall in order to place the breast implants beneath this layer.

Perhaps one of the possible advantages of subfascial implant placement is that it can isolate the device from the breast tissue, which leads to greater accuracy during mammogram examination.

Another benefit is the shorter recovery because the chest muscles are not disturbed, which is the case in submuscular implant placement.  And for this reason, patients can also expect less swelling, bruising, pain, tenderness, and other postoperative symptoms.

In terms of breast appearance, the technique provides a very natural result because it mimics the innate movement and contour of the tissue.  In addition, it provides added support from the strong fascia layer.

And unlike the subglandular implant placement, the subfascial technique prevents the risk of visible and palpable wrinkling because there is a fibrous fascia that provides coverage to the implant shell.

While the subfascial placement can lower the risk of capsular contracture (hardening of the scar tissue around the implants) compared with the subglandualr technique, it is not as effective as the submuscular implant placement which completely isolates the breast implants from the tissue, which is believed to harbor high levels of bacteria that can potentially increase the risk of complication.

Advocates of this new implant technique believe it works well for patients with small breasts and limited amounts of fats and tissue who want to achieve a smooth and natural-looking bust after breast augmentation surgery.

But for those who want to further minimize the risk of implant visibility, the submuscular implant placement is still the best technique.

Ingenious Ways to Avoid Capsular Contracture After Breast Augmentation

The development of capsular contracture is one of the most common concerns of breast augmentation patients.  This complication, which happens at about a rate of 15 percent, occurs when the scar tissue around the implants becomes abnormally thick that it ends up squeezing the devices.

Despite the relatively high rate of occurrence, not all cases of capsular contracture need a revision surgery especially if there are no symptoms such as visible distortion and pain.  However, women who are experiencing severe discomfort and have developed ball- or coconut-shaped breasts will likely need another breast augmentation.

In the early stages of capsular contracture, the complication can be treated with non-surgical methods such as taking antibiotics and certain medicines, and performing breast massage.  For this reason, any unexpected changes in the breasts particularly hardness of the tissue should be immediately reported to a plastic surgeon.

But as the cliché goes, nothing is far better than to prevent capsular contracture than to treat its symptoms.  Fortunately, plastic surgeons nowadays have a deeper understanding of how this complication occurs. 

These are the six most ingenious ways to avoid or at least minimize the chance of capsular contracture from occurring:

1.     Avoid smoking well in advance of the procedure and during recovery.  Several studies have suggested that the nicotine’s ability to constrict the blood vessels not just inhibits proper oxygen delivery but also lead to higher risk of capsular contracture and gangrene.

In fact, smokers face great risks during and after surgery that plastic surgeons today will likely decline to conduct an operation unless they will quit the habit at least three weeks before and after surgery.

2.     Use of no-touch technique.  Also called as the Keller Funnel technique, it involves the use of a pouch (lubricated with a special solution) where the implants are placed.  The narrower end of the device is then squeezed in order to transfer the implant to the breast pocket without actually touching it.

With this technique, doctors can prevent contaminating the implants with staph bacteria present in the patient’s skin, which in turn lowers the risk of capsular contracture.

3.     Avoiding incision in the breast’s sub-muscular space.  This area is known to harbor bacteria, which is one of the most common causes of capsular contracture.

4.     Creating an oversized breast pocket.  With this technique, the scar tissue, which normally forms around the implants, will not put pressure or squeeze the breast implants in case it becomes thicker than it should be.

5.     Breast massage.  While not all plastic surgeons recommend postoperative breast massage, some experts say that it can minimize the risk of capsular contracture by preventing the scar tissue from becoming hard and thick.

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Corrective Breast Augmentation for High-Riding Breasts

Breast augmentation, as its name suggests, augments the organ highly associated with femininity and sensuality.  And with the advances in plastic surgery, today the procedure is reasonably safe to many women that it has been the most popular “medical enhancement” over the past couple of years.

But one consideration to make is the risk of capsular contracture, a condition in which the scar tissue that normally forms around the breast implants becomes too thick that it ends up compressing the devices.  In severe cases, it results to visible distortion and pain.

Visible distortion may be manifested by a ball- or coconut-shaped breast or a high-riding bust.  In order to treat this problem, a revision plastic surgery is performed by doctors in which they remove the thick scar tissue and replace the breast implants with new ones.

Many plastic surgeons recommend replacing the breast implants to avoid or at least minimize the risk of infection, believed to be one of the causes of capsular contracture.

During a revision surgery, doctors avoid contaminating the breast implants so they apply the no-touch technique in which they use a funnel with a special lubrication.  With this procedure, the implants are placed inside the pouch which is then squeezed to its narrower end to push the devices into the breast pocket.

This technique, which is also called as the Keller Funnel, not just reduces the risk of contamination but also minimizes the pressure applied to the breast implants so the durability of their outer shell is not compromised during the implantation process.

To further avoid the recurrence of capsular contracture and high-riding breasts, plastic surgeons position the implants behind the muscle rather than on top of it so there will be less contact with the tissue, which is believed to harbor bacteria.

But instead of removing the scar tissue and replacing the breast implants with new ones, some doctors prefer to release the scar capsule using an electrocautery device.  This approach is particularly ideal for patients with a small amount of tissue and fats in their breasts, predisposing them to higher risk of visible and/or palpable wrinkling.

Patients with a high-riding bust or other forms of visible distortion due to capsular contracture should take into consideration that not all breast augmentation surgeons are adept in revision breast implant surgery, which requires a more complex skill.

Just to be sure, a patient should choose a doctor who has an extensive experience in conducting revision breast augmentation.

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