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

[BACKGROUND] 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.

[OBJECTIVES] 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.

[METHODS] 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.

[RESULTS] 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).

[CONCLUSIONS] 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.

[LEVEL OF EVIDENCE: 3] (Therapeutic).