Subfascial Breast Augmentation

In recent years, subfascial breast augmentation has become the most common plastic surgery among women in aesthetic surgery.

Today there are many different approaches, places for implant placement, pockets, and there are many manufacturers that produce breast implants, and various forms of implants.

Location of the implant – a matter in which a woman is interested, and a decision that the plastic surgeon should make.

The implant can be installed:

a) under the mammary gland (subglandular);
b) under the fascia of the pectoralis major muscle (subfascial);
c) under the pectoralis major muscle (submuscular).

What is subfascial breast augmentation?

Subfascial Breast Implant Placement

To achieve the most natural result, the breast implant must have adequate cover by soft tissues of the mammary glands. If surgeon do not observe this criterion, the edge of the implant can be seen or felt.

Setting the breast implant under the gland has significant drawbacks, especially when there is no thickness of breast soft tissue for sufficient covering of implant. In addition to imaging and palpation, when the implant under the gland complications occur more frequently, such as fibrous capsular contracture, irregularities, bumps, violation of nipple sensitivity.

Installation of the implant under the pectoralis major muscle became popular when it was revealed that it avoids the shortcomings of the implant placement under the gland.

Subfascial Breast Augmentation Before And After

The disadvantages of implant placement under the pectoralis major concerns most traumatic surgery, postoperative period is more severe than in the implant under the mammary gland, as well as the fact that breasts may flatten or deform when reducing the pectoralis major muscle. If surgical techniques in the pectoral muscle will be executed wrong, the implant can be moved upward or downward and outward.

The true solution to the problem of providing a sufficient amount of soft tissue to cover the implant without deformation of the breast while reducing the pectoralis major muscles in the postoperative period is the installation of the implant under the fascia of the pectoralis major muscle.

The fascia of the pectoralis major muscle is well-defined layer, it can be used to prevent visualization of the implant edge beneath the skin, while pectoralis major muscle is not damaged (it remains intact), and the implant is thus completely covered with soft tissues.

Subfascial Implants Before and After Pictures

The fascia covers the implant securely. When the implant under the fascia the breasts will not deform while contraction the pectoralis major muscles in the postoperative period. You will also be able to avoid complications such as implant displacement under the influence of the contraction.

The purpose of the installation of the implant under the pectoralis major muscle fascia is to provide beautiful, natural-looking breast shape. Fascia is a added soft tissue layer between the implant and the skin, moreover, it increases the elasticity of coating tissue, thereby reducing the degree of visualization of the implant edge.

The surgeon can perform breast augmentation by setting the implant under the pectoralis major muscle fascia, through access:

  1. in the armpit (transaxillary access)
  2. in the crease under the breast (submammary access)
  3. Subfascial Breast Implants

  4. on the lower edge of the areola (periareolar access).

Choice of access depends on the patient’s desires, its anthropometric characteristics and number of pregnancies.

Endoscopic breast augmentation through the axillary access is ideal for women with small breasts, as well as for women with flabby skin, but without ptosis of the mammary glands. The advantage of endoscopic breast augmentation through the axillary approach is that it allows to do without scars on the breast.

Access in crease under the breast provides ability to install a larger implants. When breast augmentation performed through the axillary access or access through inframammary fold, the mammary parenchyma remains intact. For patients with a minimal degree of breast ptosis or ptosis of the areola suitable access through the areola.

Before And After Subfascial Implants

Procedure of subfascial transaxillary breast augmentation

  1. Initially the surgeon makes an incision about 4 cm in the crease of the armpit, from the anterior axillary line without going over the edge of a large pectoral muscles, thereby hiding any possible scars.
  2. After incision, the superficial fascia of the pectoralis major muscle is localized and incision is made parallel to the muscle fibers in the same edge of the muscle.
  3. Further, dissection is carried out under the fascia of pectoral large muscle and over muscle fibers using a laryngoscope with an endoscopic system. After reaching maximum depth, the surgeon makes horizontal incision in the fascia at level of 6 rib and produces subcutaneous dissection to level of desired thoracic groove.
  4. Photo Subfascial Breast Implant Placement

  5. After drawing design of the pocket for the implant, measuring implant is installed, filled with saline solution, allowing to determine the required volume, as well as to compare the symmetry of both sides. Then, these implants are removed, and hemostasis is verified using an endoscope. Next, the surgeon marks dots on the skin for insertion final implants using mirroring or the implant template.
  6. Anatomic implant is inserted. Then, with the help of endoscope, is verified the position of the implant with the marked points for the correct position.
  7. The surgeon places the drainage and sews axillary incision. We consider fundamental to wear a bandage for one week, which will support the implant in place. After that, during the month of sleeping on your side with the bent leg and supporting bra. Drainage is removed after 24 hours after surgery.

Subfascial level in comparison with submuscular and subglandular. With the use of anatomical implants at subfascial level:

Subfascial Breast Augmentation Photos

  • Is achieved good filling of the chest area and the upper area due to subglandular placement of the implant.
  • Fast recovery after surgery.
  • Do not increase the risk of ptosis due to the support of the implant with the help of the fascia, fiber connection between the deep layer of the fascia and the fascia of the pectoralis major muscles remain untouched.

In connection with all this, we consider that the placement of anatomic implants through the armpit area at subfascial level is a combined technology, which has absorbed the advantages of several methods. As anatomical implants filled with gel “soft touch” (softer than the other), their placement is easier. Using endoscopy allows to achieve excellent results.

Postoperative care

Before And After Subfascial Breast Implant Surgery

After subfascial breast augmentation is recommended to wear a special compression underwear for 1 month. If endoscopic breast augmentation was performed through the axillary approach, it recommended to wear a compression elastic bandage in the upper slope of the breast for 10-14 days, which allow to hold the implant in the correct position. After one month, the movement of the hands is allowed in full.


One of the complications of subfascial breast augmentation is the displacement of the implant. Shifting down of the implant may occur in patients with loose skin. Displacement of the implant to the top is typical for endoscopic breast augmentation through the axillary access. Other complications, capsular contracture, hematoma, decrease in sensitivity, mammary glands asymmetry, seroma, infectious complications are rare. After conducted researches plastic surgeons have come to the conclusion that the least amount of complications occur during the installation of implants under the fascia of pectoralis major muscle (subfascial).


Subfascial Buttock Implants

Installation of implant under the fascia of pectoralis major muscle during breast augmentation, allows you to create natural breast shape and provides good coverage of the implant by breast tissues. In addition, the fascia of the pectoralis major muscle eliminates the possibility of damage to implant during pectoralis major muscle contraction.

The frequency of possible complications is not higher than that with other techniques installation of implants for breast augmentation. Compared with the installation of implant under the pectoralis major muscle, subfascial breast implants allows you to create the best breast contour, and the result looks more natural. The incidence of long-term complications, capsular contracture, which is typical for subglandular implant placement, when applying this technique is much lower.