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Selection of Breast Augmentation – Differences between Endoscopic Subpectoral and Endoscopic Subfascial Augmentation Mammaplasty

Augmentation mammaplasty has experienced more than forty years of development. With the wide application of endoscope in the recent years, the drawbacks of traditional surgery including bleeding and pain have been eliminated. Therefore, consumers nowadays are willing to accept this type of aesthetic surgery for the satisfaction of their soul and mind.

With the diverse selection of surgery, the two main trends have gradually evolved into subpectoral and subfascial implants. Since the editor notices outpatients are specious about the concept of these implants, this article is composed to provide clarification and accurate information.

As implied by the name, subpectoral implant is the insertion of implant under the pectoral muscle while the subfascial implant is inserted underneath the fascia. Traditionally, subpectoral implant requires stripping of muscle at the adhesive area. Therefore, the post-operative pain and swelling are relatively visible. Moreover, post-operative massage may affect the softness of breast due to the hand motion or exercise, which also causes the extended duration for post-operative care. Since most Asian females have small body frame and flat chest, the extra layer of muscle to cover the implant will assist in the natural-looking of breast shape. Therefore, subpectoral augmentation mammaplasty has been widely adopted, especially for those with less satisfied criteria for breast augmentation and saline-filled implant.

On the contrary, subfascial augmentation mammaplasty involves the insertion of implant on the fascia layer above the pectoral. Since this surgery does not involve the damage of adhesive point on the muscle, the main advantage is decrease of pain. As the skin is relatively soft, the firming of breast is more rapid than subpectoral implant. With less post-operative pain, there is less issues with self-care. However, candidates with less satisfied inborn conditions (such as flat chest and funnel chest) and underweight candidates are not recommended for this surgery due to the unnatural appearance mimicking the shape of a round ball (the shape intensifies when laying down). With the pros and cons previously mentioned, the editor has summarized the following key points for the readers’ reference before breast augmentation:

Candidates suitable for subpectoral augmentation mammaplasty:

	Flat chest (such as cup size A) or thin person
	Big cup size (those who desire cup size above E)
	Family history with breast cancer or breast disease
	Saline-filled implant candidates

Candidates not suitable for subpectoral augmentation mammaplasty:

	Athlete or dancer
	Candidates who require frequent arm movement at work
	Candidates with thick chest muscle
	Distinctive breast shape including tubular breasts, pointed breasts or severely sagging breasts

Candidates suitable for subfascial augmentation mammaplasty:

	Athlete or person with frequent arm exercise
	Candidates who are extremely fear of pain
	Candidates with adequate natural criteria (cup size B and above)
	Cohesive silicone gel implant candidates

Candidates not suitable for subfascial augmentation mammaplasty:

	Flat chest or underweight candidates (with skin thickness less than 1cm)
	Candidates who desire for large breasts (cup size E and above)
	Medical history of mastitis and other diseases
	Saline-filled implant candidates
	Inborn chest deformity (such as pectus carnatum or pectus excavatum)

Most readers may have discovered that the two types of surgery are complementary to one another. Since there is no single surgery that will satisfy all breast augmentation patients, the surgeons have to make the optimal suggestions. At the same time, the surgeons have to consider the patients’ occupation and inborn conditions with their experience and professionalism. During outpatient services, detailed communication and assessment are necessary to eventually acquire the satisfactory results for both patients and surgeons. As a smart consumer, have you done your homework and ready to bring on a test for your plastic surgeon?

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