One of the most common questions we get when patients are considering a breast augmentation procedure is, “What is the difference between a subfascial and dual plane and preservation procedure?”
When patients ask this, they are asking for everything in terms of recovery, the appearance of the breast, and the actual surgical technique itself.
Let’s start from the beginning by asking, “What am I going to look like after a breast augmentation with either a subfascial, dual plane, or preservation procedure?”
It is honestly really hard most of the time for patients to know whether somebody had a subfascial plane or preservation breast procedure. There are a lot of factors that go into the final result after a breast procedure, not just the placement of the implant under the muscle, half under the muscle, above the muscle, or using one of these breast preservation procedure techniques.
The factors that will affect what your breasts ultimately look like are:
- Your natural anatomy.
- The type of implant that you use.
- The size of the breast implant that you have.
The relationship between the starting size of your breasts, the tightness of your breasts, the shape of your breasts, and the breast implant itself is going to have a huge role in what you ultimately look like. This can be especially apparent if you are not combining your breast augmentation with a breast lift procedure.
When we talk about the breast augmentation procedure itself, subfascial augmentation means that you are placing the implant above the muscle, but still lifting the fascia, or strong covering, around the muscle. The reason that this has been done for a long time is that it was the benefit of placing the implant above the muscle to avoid any animation, some of the movements, and so you do not actually have to have the tightness and pressure of the muscle being down. You also had more control of the breast pocket because you weren’t limited to where the pectoralis muscle is, but received some of the benefits of that fascia helping stabilize the breast itself.
Additionally, some studies and theories have stated that being underneath that fascia would help decrease the risk of what we call capsular contracture. This is a capsule of fibrous scar tissue that can develop around the implant. So the subfascial procedure was a really nice concept to help, and something that we do often in our practice here at Austin Plastic Surgeon.
Dual plane breast augmentation was a concept developed to help experience the benefits of being under the muscle while still receiving many benefits associated with subfascial or subglandular procedures that place the implant above the muscle.
The idea behind a dual plane, or partially under the muscle breast augmentation, was that it was going to help the overall appearance of the breast implant, especially in the past when we used a lot of saline implants. These implants are firm, they are round, they are more prone to rippling, but the muscle would provide coverage around the implant and soften the appearance and feel of the breast implant.
I think back when saline implants were the only option, and having some of the muscle covering the implant was a huge advantage in breast augmentation procedures.
As the implant options have evolved and innovation has continued to move forward, we have so many more options for patients and plastic surgeons. I think this innovation in breast implant technology is what has allowed us to perform techniques such as subfascial or breast preservation procedures and really tailor the results to what patients desire.
When we talk about a breast preservation procedure, the idea is that the implants are above the fascia, but below the gland of the breast tissue itself. This means that all the glandular tissue of the breast is still lifted and positioned above the breast implants so it can be easily seen on mammograms.
This area contains natural space, making it ideal for breast preservation procedures to come into vogue. Patients are typically awake for these breast preservation procedures, so it is important that they are super comfortable. Hydrodissection using saline can be performed before you can use a specialized balloon to create the space for the implants.
You are not cutting any of the natural tissue, and the ligaments of the breast are maintained, creating a natural internal bra for the implants to be supported. It also has a nesting effect that pulls and supports the implant while being stabilized with the breast itself.
If you think about it, recovery tends to be a spectrum. In all fairness, most breast augmentation procedures have some element of rapid recovery built in. I do think that implants placed under the muscle are going to have a little bit more recovery time, as you are going to feel that tightness and pressure under the breast.
As we go further above the muscle, specifically above the muscle and under the fascia, it is going to have an even faster recovery, as you are not going to feel the stretching and tightening of the muscle.
I think people are going to have the most rapid recovery after undergoing a breast preservation procedure. There are a couple of reasons for that:
- You are not cutting anything, so there’s less healing to do underneath the breast.
- You are not touching the muscle, so that’s completely left alone.
- Many of the breast preservation procedures are done with sedation, so people are awake for the procedure. This means that they do not have to experience any of the anesthesia recovery.
Breast preservation has really become a very popular procedure for many patients.
I do think, from a guiding pearls standpoint, in terms of what procedure is best for you:
If you are placing implants above the muscle, you are definitely going to avoid some of the problems that we have had in the past with under-the-muscle placement. This includes concerns, such as animation or a limitation of cleavage because of where that muscle border is medially.
If you are using a saline implant, there is no question that I think patients tend to do a little bit better under the muscle. These implants generally tend to be very firm and are more prone to rippling.
For patients looking for a rapid recovery, really good control of the breast, minimal destruction or distortion of the breast, I think the breast preservation procedure is going to become increasingly popular. This procedure can be performed on its own or in combination with other procedures, such as breast lifting and reductions.
Ultimately, it is important to talk to your plastic surgeon about each breast augmentation technique. There are a lot of great options, and which procedure is best for you will be determined by your own natural anatomy and goals.