Aesthetic Plastic Surgery

, Volume 43, Issue 6, pp 1429–1436 | Cite as

Is There a Breast Augmentation Outcome Difference Between Subfascial and Subglandular Implant Placement? A Prospective Randomized Double-Blinded Study

  • Ivan Maluf JuniorEmail author
  • Ruth Maria Graf
  • Adriana Sayuri Kurogi Ascenço
  • Willian Itikawa
  • Priscilla Balbinot
  • Alexandre Mendonça Munhoz
  • Marlon Câmara Lopes
  • Isis Juliane Guarezi Nasser
  • Linei Augusta Brolini Dellê Urban
  • Renato da Silva Freitas
Original Article Breast Surgery



Subfascial breast augmentation is gaining popularity because of no distortion when the pectoral muscle is contracted and minimizing visualization of the edges of the implant. Although some studies have reported a satisfactory outcome with subfascial technique, it still is controversial the influence of the pectoral fascia and outcome compared to the subglandular technique. Therefore, this prospective randomized study aimed to investigate whether there are clinical/radiological differences between subfascial and subglandular pockets following primary breast augmentation.


Twenty patient candidates for primary breast augmentation were recruited. Each patient was selected for subfascial or subglandular pockets in a randomized fashion. Both patient and surgeon were blinded. Clinical and radiological differences were evaluated through five independent surgeons and MRI (capsule, folds, fluids, base and projection). Median follow-up was 12 months.


Breast consistency (p = 0.24), implant pocket (p = 0.52), symmetry (p = 1), contour, and shape (p = 0.09) demonstrated no statistically significant difference after the surgeons’ assessments at 3 and 12 months after surgery. MRIs demonstrated a larger implant base in the subfascial group (p = 0.024). No differences were observed in capsule thickness (p = 0.42), folds (p = 0.51), fluids (p = 0.28), or projection (0.20).


The choice between subfascial and subglandular planes shows no clinical differences and can be selected according to individual professional experience, not evidencing any advantages of one over the other.

Level of Evidence II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Breast augmentation Subfascial technique Subglandular technique Outcome Complication Prospective study Magnetic resonance imaging 


Compliance with Ethical Standards

Conflict of interest

Breast implants were donated by Silimed. MRIs were freely held at DAPI (Diagnóstico Avançado por Imagem—Center of Advanced Imaging Diagnosis). None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, all the patients had signed the informed consent.


  1. 1.
    American Society of Plastic Surgeons (2013) Cosmetic plastic surgery statistics. Accessed 8 May 2014.
  2. 2.
    Spear SL, Bulan EJ, Venturi ML (2004) Breast augmentation. Plast Reconstr Surg 114:73–81CrossRefGoogle Scholar
  3. 3.
    Lista F, Ahmad J (2013) Evidence-based medicine: augmentation mammaplasty. Plast Reconstr Surg. 132(6):1684–96CrossRefGoogle Scholar
  4. 4.
    Adams WP Jr, Mallucci P (2012) Breast augmentation. Plast Reconstr Surg. 130:597e–611eCrossRefGoogle Scholar
  5. 5.
    Graf RM, Bernardes A, Rippel R et al (2003) Subfascial breast implant: a new procedure. Plast Reconstr Surg 111:904–911CrossRefGoogle Scholar
  6. 6.
    Goes JC, Landecker A (2003) Optimizing outcomes in breast augmentation: seven years of experience with the subfascial plane. Aesth Plast Surg 27:178–186CrossRefGoogle Scholar
  7. 7.
    Jinde L, Jianliang S, Xiaoping C et al (2006) Anatomy and clinical significance of pectoral fascia. Plast Reconstr Surg 118:1160–1557CrossRefGoogle Scholar
  8. 8.
    Benito-Ruiz J (2004) Subfascial breast implant. Plast Reconstr Surg 113:1088–1091CrossRefGoogle Scholar
  9. 9.
    Stoff-Khalili MA, Scholze R, Morgan WR, Metcalf JD (2004) Subfascial periareolar augmentation mammaplasty. Plast Reconstr Surg 114:1280–1289CrossRefGoogle Scholar
  10. 10.
    Ventura OD, Marcello GA (2005) Anatomic and physiologic advantages of totally subfascial breast implants. Aesthetic Plast Surg. 29(5):379–383CrossRefGoogle Scholar
  11. 11.
    Hunstad JP, Webb LS (2010) Subfascial breast augmentation: a comprehensive experience. Aesthetic Plast Surg 34(3):365–73CrossRefGoogle Scholar
  12. 12.
    Tijerina VN, Saenz RA, Garcia-Guerrero J (2010) Experience of 1000 cases on subfascial breast augmentation. Aesthetic Plast Surg. 34(1):16–22CrossRefGoogle Scholar
  13. 13.
    Munhoz AM, Fells K, Arruda E, Montag E, Okada A, Aldrighi C, Aldrighi JM, Gemperli R, Ferreira MC (2006) Subfascial transaxillary breast augmentation without endoscopic assistance: technical aspects and outcome. Aesthetic Plast Surg. 30(5):503–512CrossRefGoogle Scholar
  14. 14.
    Munhoz AM, Gemperli R, Sampaio Goes JC (2015) Transaxillary subfascial augmentation mammaplasty with anatomic form-stable silicone implants. Clin Plast Surg. 42(4):565–584CrossRefGoogle Scholar
  15. 15.
    Sampaio Goes JC, Munhoz AM, Gemperli R (2015) The subfascial approach to primary and secondary breast augmentation with autologous fat grafting and form-stable implants. Clin Plast Surg. 42(4):551–564CrossRefGoogle Scholar
  16. 16.
    Pereira LH, Sterodimas A (2009) Transaxillary breast augmentation: a prospective comparison of subglandular, subfascial, and submuscular implant insertion. Aesthetic Plast Surg. 33(5):752–759CrossRefGoogle Scholar
  17. 17.
    Brown T (2011) Subfascial breast augmentation: Is there any advantage over the submammary plane? Aesthetic Plast Surg. 34(3):365–373Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • Ivan Maluf Junior
    • 1
    Email author
  • Ruth Maria Graf
    • 2
  • Adriana Sayuri Kurogi Ascenço
    • 1
  • Willian Itikawa
    • 1
  • Priscilla Balbinot
    • 1
  • Alexandre Mendonça Munhoz
    • 4
    • 5
  • Marlon Câmara Lopes
    • 1
  • Isis Juliane Guarezi Nasser
    • 1
  • Linei Augusta Brolini Dellê Urban
    • 3
  • Renato da Silva Freitas
    • 2
  1. 1.Aesthetic and Reconstructive Plastic Surgery Service at Hospital de ClínicasUniversidade Federal Do Paraná (UFPR)CuritibaBrazil
  2. 2.Plastic Surgery Service at Hospital de ClínicasUFPRSao PauloBrazil
  3. 3.Diagnóstico Avançado Por Imagem (Center of Advanced Imaging Diagnosis), DAPICuritibaBrazil
  4. 4.Hospital Sírio-LibanêsSão PauloBrazil
  5. 5.Hospital MoriahSão PauloBrazil

Personalised recommendations