Subpectoral vs Subfascial Cosmetic Breast Augmentation: Are We Ready to Settle?

Abstract

Utilization of the subfascial plane in breast augmentation has many purported advantages. To further develop our understanding of the potential advantages of the subfascial augmentation technique a direct comparison to the ubiquitous subpectoral (dual-plane) technique is required. The goal of this study was to provide the first direct comparison of postoperative outcomes observed in subfascial and subpectoral breast augmentations utilizing an inframammary incision. A retrospective chart review was performed identifying all patients who underwent either subfascial or subpectoral cosmetic breast augmentations by a single surgeon between 2011 and 2023. Acute and late complications were identified with particular attention to the double bubble deformity, lateral implant malposition, and capsular contracture. In total, 193 patients (386 breasts) were identified for the study. Of 193, 96 patients (192 breasts, 49.7%) underwent subpectoral augmentation, and 97 patients (194 breasts, 50.3%) underwent subfascial augmentation. A total acute complication rate of 1.0% was observed. The acute complication rate between the 2 groups was statistically insignificant (1/194 [0.5%] subfascial vs 3/192 [1.6%]) subpectoral, P = .61). Compared to the subpectoral cohort, the subfascial cohort demonstrated a statistically significant lower rate of capsular contracture (2/194 [1.1%] subfascial vs 10/192 [5.2%]) subpectoral, P = .04), lateral implant malposition (17/194 [8.8%]) subfascial vs 45/192 [23.4%]) subpectoral, P = <.001) and double bubble deformity (0/194 [0%] subfascial vs 7/192 [3.7%] subpectoral, P = .02). Use of the subfascial plane in cosmetic breast augmentation offers several advantages over the traditional subpectoral (dual-plane) approach. These include reduced rates of lateral malposition, double bubble deformity development, and capsular contracture. These findings suggest that subfascial breast augmentation may be a superior option for many patients, particularly those who are physically active or concerned about long-term pectoralis muscle function. (Therapeutic).