Abstract
Introduction
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.
Methods
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.
Results
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).
Conclusion
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 www.springer.com/00266.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Society of Plastic Surgeons (2013) Cosmetic plastic surgery statistics. https://www.plasticsurgery.org/news/plastic-surgery-statistics/2013.html. Accessed 8 May 2014.
Spear SL, Bulan EJ, Venturi ML (2004) Breast augmentation. Plast Reconstr Surg 114:73–81
Lista F, Ahmad J (2013) Evidence-based medicine: augmentation mammaplasty. Plast Reconstr Surg. 132(6):1684–96
Adams WP Jr, Mallucci P (2012) Breast augmentation. Plast Reconstr Surg. 130:597e–611e
Graf RM, Bernardes A, Rippel R et al (2003) Subfascial breast implant: a new procedure. Plast Reconstr Surg 111:904–911
Goes JC, Landecker A (2003) Optimizing outcomes in breast augmentation: seven years of experience with the subfascial plane. Aesth Plast Surg 27:178–186
Jinde L, Jianliang S, Xiaoping C et al (2006) Anatomy and clinical significance of pectoral fascia. Plast Reconstr Surg 118:1160–1557
Benito-Ruiz J (2004) Subfascial breast implant. Plast Reconstr Surg 113:1088–1091
Stoff-Khalili MA, Scholze R, Morgan WR, Metcalf JD (2004) Subfascial periareolar augmentation mammaplasty. Plast Reconstr Surg 114:1280–1289
Ventura OD, Marcello GA (2005) Anatomic and physiologic advantages of totally subfascial breast implants. Aesthetic Plast Surg. 29(5):379–383
Hunstad JP, Webb LS (2010) Subfascial breast augmentation: a comprehensive experience. Aesthetic Plast Surg 34(3):365–73
Tijerina VN, Saenz RA, Garcia-Guerrero J (2010) Experience of 1000 cases on subfascial breast augmentation. Aesthetic Plast Surg. 34(1):16–22
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):503–512
Munhoz AM, Gemperli R, Sampaio Goes JC (2015) Transaxillary subfascial augmentation mammaplasty with anatomic form-stable silicone implants. Clin Plast Surg. 42(4):565–584
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):551–564
Pereira LH, Sterodimas A (2009) Transaxillary breast augmentation: a prospective comparison of subglandular, subfascial, and submuscular implant insertion. Aesthetic Plast Surg. 33(5):752–759
Brown T (2011) Subfascial breast augmentation: Is there any advantage over the submammary plane? Aesthetic Plast Surg. 34(3):365–373
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Junior, I.M., Graf, R.M., Ascenço, A.S.K. et al. Is There a Breast Augmentation Outcome Difference Between Subfascial and Subglandular Implant Placement? A Prospective Randomized Double-Blinded Study. Aesth Plast Surg 43, 1429–1436 (2019). https://doi.org/10.1007/s00266-019-01465-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-019-01465-8