Subfascial Breast Augmentation & “Repairing the Gap”
IF YOU’VE LOST YOUR YOUTHFUL BREAST VOLUME DUE TO PREGNANCY, CANCER OR SUBSTANTIAL WEIGHT LOSS – OR YOU WERE SIMPLY BORN WITH A SMALL OR ASYMMETRICAL CHEST – OUR RENOWNED SUBFASCIAL BREAST AUGMENTATION MAY BE JUST THE SOLUTION YOU NEED. IT CAN RESTORE A FULL CHEST IN AN EXTREMELY NATURAL WAY – GIVING YOU THE SENSUAL LOOK YOU DESIRE.
Welcome to one of the most popular procedures in the USA – Breast Augmentation. Many women just want to be able to wear a bathing suit that fits better. Others want to obtain the flattering figure they always desired. Moms seek breast augmentation surgery because they lost their breast size after breast-feeding. There are also physical reasons, such as small, underdeveloped, or unusually shaped breasts or size reduction due to weight loss. When a breast is lost to breast cancer, breast reconstruction is an option many women choose.
With more than 50% of the breast surgeries at the Clinique of Plastic Surgery performed to correct or revise previous breast surgeries, Dr. Drehsen has developed innovative methods to deal with breast augmentation problems.
Dr. Drehsen’s “Subfascial Breast Augmentation” & “Inner Bra” techniques are part of our signature procedures at the Clinique of Plastic Surgery. This innovative breast augmentation technique uniquely addresses the needs of athletic and physically active women considering breast augmentation for the first time or who have had previous implants migrate sideways causing a loss of cleavage and fullness. The displacement can be corrected by placing new implants under the fibrous layer (fascia) of the pectoral muscle instead of under the muscle fibers.
Choices of Breast Implants
Saline and Silicone implants are now available in multiple increments of volume and width to fit individual chest and breast configurations. Both saline and silicone gel breast implants are proven to be safe, effective, and long lasting. Saline implants, while more versatile can feel less natural, especially under thin tissue. Silicone implants come pre-filled in many sizes with a safe, more cohesive silicone gel. They look and feel more natural but are less versatile in correcting breast size discrepancy and require slightly wider incisions. Since silicone implant degradation or rupture is not as obvious as saline implant deflation, the prevailing recommendation is to replace the implants after ten years.
Choice of Incisions and Breast Implant Placements
There are several incisions or approaches for breast augmentation. The incision choice generally depends on the work to be done to improve the gland shape or position. We routinely use 3 different approaches for your breast augmentation procedure: The submammary (in the new crease below the breast), the infra-areolar (thru the lower border of the areola), or the transaxillary incision (armpit), depending on your needs. Once the incision is made, the surgeon lifts the breast tissue to create a surgical pocket that will house the implant. This pocket will either be under the breast tissue (subglandular), underneath the pectoral muscle cover (subfascial), or under the muscle itself (submuscular).
One of our favorite approaches for well-shaped breasts is the armpit incision, which leaves a virtually invisible scar. Additionally, there are several choices for implants which our doctors will discuss in a formal consultation. Different types of implants are available to fit your specific needs, your budget, as well as the ultimate shape you would like to obtain.
Reasons for Breast Augmentation
You are a good candidate for considering breast augmentation if you can identify with any of the following indications:
Cosmetic breast augmentation of underdeveloped breasts Asymmetrical breasts Abnormal breast shape such as conical deformity Post-delivery, weight loss, tissue sagging, and loss of volume Breast reconstruction after surgical removal (Total or partial)
The Clinique’s Choice of Breast Implant Placements
Classically, patients are usually presented with only two choices; a sub-muscular breast augmentation or a sub-glandular breast augmentation. Unfortunately, due to individual variations like a strong and tight pectoral muscle, weak surrounding tissues after childbirth, large implant requests and the like, these two choices can have some significant drawbacks. In a sub-muscular placement, the constant muscle activity over the implant has often led to implant dislocations sideways (with loss of cleavage: “The Gap”), downward (Bottoming), or upward (thick bosom look or “snoopy breasts”), sometimes within only a couple of years.
These late displacements are, unfortunately, not totally predictable or preventable. The sub-glandular augmentation on the other hand, appears to maintain the cleavage better. However, in some cases of loose tissue, they may show more secondary encapsulation, sagging, and rippling.
The subfascial breast augmentation is often recommended by Dr. Drehsen, particularly for athletic or physically active women. In this approach, the fibrous layer, or “fascia,” covering the outer surface of the muscle is elevated from the muscle, allowing support of the implant by a strong fibrous sheath. This, in Dr. Drehsen’s experience, reduces breast implant displacement since the muscle activity does not affect the breast implant placed in front of it and also may reduce sagging and encapsulation due to the presence of this supporting fibrous sheath. The procedure is slightly longer due to the thorough nature required to create a sub-fascial pocket.
NOTE: The subfascial placement is usually done through an inframammary incision or a trans-areolar one when feasible. The key to making the inframammary scar inconspicuous is placing the incision in the projected new fold, not in the existing one. This subfascial approach eliminates many of the problems described above and maintains the new cleavage more effectively than submuscular or dual plane placement. The subfascial approach can also be used to correct moderate sagging and nipple mal-positioning without external incisions. When a very thin or shrunk glandular tissue is present we have recently added Fat Micrografting to the upper portion of the breast to camouflage the implant or enhance the “décolleté.” In this latest development, also known as Structural Fat Grafting, some fat is extracted from the belly or hip area by a mini liposuction, processed and re-injected in a layered fashion in the breast mound.
As an alternative, when the upper portion of the breast is quite thin, a Dual Plane Placement (Sub muscular-Subfascial) can be a good choice to avoid post-surgical deformities such as implant rippling, “double bubble” deformity (original breast shape visible on top of the implant), “snoopy breasts” (a submuscular implant placed too high under the muscle), or to help correct nipple position, asymmetry, and early sagging. The procedure involves placing the implant partially under the muscle to help correct shape or position problems.