Is Subfascial Breast Augmentation With Motiva Right for You in San Francisco?

Overview

• Subfascial placement sets the implant beneath the sheet of connective tissue covering the pectoral muscle, so you gain a layer of coverage without the muscle being cut.

• The muscle stays whole, and that accounts for most of the recovery difference patients notice.

• Fascia adds a millimeter or two of thickness, and helps to create a snug “pocket” for your implant

• Your breast tissue thickness helps to determine if you are the ideal candidate for Motiva breast implants placed over the muscle, but under the fascia.

1. The Layer Most Patients Have Never Heard Of

Almost everyone who sits down in my office arrives knowing two options, over the muscle and under it. Subglandular puts the implant behind the breast tissue and on top of the muscle, while submuscular means dividing the lower fibers of the pectoralis and sliding the device beneath them.

There's a third position, called “subfascial” or under the fascia. The pectoralis carries a tough covering of connective tissue across its surface, and this white, stringy tissue is called the fascia.

In a subfascial augmentation I lift that sheet off the muscle and set the implant into the space behind it, so the muscle stays whole. I create a circular pocket under the fascia for your breast implant.

2. Why the Implant Matters More in This Plane

Underneath the muscle, a breast implant has muscle, breast tissue, and skin for “padding” over your implants. With subfascial placement, there is no muscle - just your breast tissue and padding. This is why some patients may not be candidates, or I may suggest fat grafting to give additional “padding” as well as cleavage to your breast augmentation for the best long term results.

[LINK: What Makes Motiva Implants Different?]

None of this is brand specific necessarily. Any well-made soft cohesive device should do well in the subfascial plane, since the requirement is softness.

3. The Animation Problem This Plane Solves

In some patients who have had under the muscle or dual plane placement of the implants, some patients flex their pectoralis muscles, and you can see their breast implants flex or move as well.

Subfascial placement reduces this risk substantially, because the muscle contracts underneath the implant. Your implant stays where it sits, and the breast implant does not move when the pectoralis is activated.

4. Who Shouldn't Have Subfascial Placement

Lean patients may not be the best candidates for subfascial placement unless they also get fat grafting.

If I am able to place a thin layer of fat at the top, middle, and lower portions of your breast implant, the edge of your implant will be less visible, will look more natural, and the slope or transition from your body towards the implant will also have a more natural transition.

If you do not have much body fat, there are options such as AlloClae or Renuva for fat placed from cadaveric sources.

[LINK: Am I a Candidate for Motiva Breast Augmentation?]

5. Recovery, and Why It's Easier

Most of the pain after breast augmentation comes from the muscle stretching, since under the muscle placement causes the breast implant to stretch the pectoralis muscle.

Breast implants placed above the muscle and under the fascia do stretch the overlying fascia, breast tissue, and breast skin, but not the muscle. This markedly reduces pain after breast augmentation.

This is a great article I wrote on “Rapid Recovery Breast Augmentation” (LINK HERE)

6. Long-Term Position and the Bottoming Out Question

Pocket precision is the answer. The surgical dissection has to be precise and matched to your body, your anatomy, and the breast implant itself.

The fascia itself provides real support, and the breast implant position holds well in appropriately selected patients.

Three Myths About Subfascial Augmentation

Myth: Subfascial is a fancier name for over the muscle. Technically, subfascial is above the muscle and under the fascia, whereas subglandular puts the breast implant above the muscle and the fascia, putting the breast implant in direct contact with your breast tissue. The subgalndular placement is thought to increase capsular contracture risk, which is why subfascial placement is more common.

Myth: The fascia is too thin to make a difference. It's thin, and it isn't negligible:

• It adds measurable thickness at the upper pole, where an edge shows first.

• It separates the implant from the ductal system and the bacteria living in it.

• It contributes connective tissue support that breast tissue alone doesn't provide.

• It stays intact, unlike a divided muscle, so nothing loses function.

Myth: Skipping the muscle makes for a shorter surgery. In experienced hands, they actually take about the same amount of surgical time in the operating room.

Frequently Asked Questions About Subfascial Breast Augmentation

• Does subfascial placement raise the risk of capsular contracture?

  The fascia keeps the implant out of contact with the duct system, and duct bacteria are a recognized contracture trigger. Paired with the smooth Motiva surface, which performed well for contracture in the FDA trial data, the risk profile in this plane looks favorable.

• Does it feel different from under the muscle?

  Both positions feel very natural. Most of the difference is based on how much natural breast tissue you started off with before your operation.

• Will it affect breastfeeding?

  Unlikely, since the dissection stays below the gland and leaves the milk ducts and glandular tissue undisturbed above the surgical plane.

• Is the scar different?

  No. The inframammary incision runs about two to four centimeters, the same as for the other implant pocket placement.

• Does this fix animation deformity from an earlier surgery?

  Yes, and it is one of the more satisfying revisions I do. The implant comes out of the submuscular pocket, the muscle gets repaired, and a fresh subfascial pocket is created.

• How much tissue do I need?

  Enough that a pinch at the upper pole reaches a workable thickness. Below that threshold a dual plane or subfascial placement with added fat grafting is a better option.

Summary

Subfascial augmentation occupies the space between the two planes most patients hear about, giving you a sheet of connective tissue over the implant while leaving the pectoralis untouched.

I have to examine you to determine the thickness at the upper pole of your breasts, skin quality, and more to determine if you’re a candidate for subfascial placement, whether you need fat grafting or if under the muscle/ dual plane placement is best for you.

---

Ready to Find Out Which Plane Fits You?

Call 415-362-1846 to schedule with Dr. Roy Kim, a board-certified plastic surgeon.

The San Francisco office is at 450 Sutter Street, Suite 1440, San Francisco, CA 94109, and the Alameda office is at 1403 Park Street, Alameda, CA 94501.

Follow and Connect with me on my social media!