Subfascial Breast Augmentation with Anatomic Cohesive Gel Silicone Implants

Friday, April 25, 2014
Bill Kortesis, MD, Phillip Khan, MD and Joseph Hunstad, MD, FACS, Hunstad-Kortesis Center for Cosmetic Plastic Surgery and Medspa, Huntersville, NC
Goals/Purpose:

Highly cohesive, silicone gel-filled, anatomically shaped breast implants have exhibited multiple benefits since their launch in 1993.  Proponents herald natural/proportionate breasts, improved longevity, decreased likelihood of capsular contracture and postoperative rippling, lower incidence of reoperation, and a “one breast feel.”1,7,8   Multiple studies have cited the success of these implants in various positions, including submuscular and subglandular 1,2,3,4,5,6 The subfascial plane of dissection, highlighted by Graf, Barbatos, and Hunstad, has become more popular with its inherent advantages of rapid recovery, satisfactory breast shape, and lower rates of fibrous capsular contracture.9,10,11We offer a consecutive series of patients all treated with either Allergan Style 410 or Sientra Textured Anatomic HP Gel implants in the subfascial position.  This series is a starting point warranting the subfascial technique as a safe and effective method of providing breast augmentation using highly cohesive anatomically shaped silicone gel implants with high patient satisfaction. 

Methods/Technique:

A consecutive series of 8 subfascial breast augmentations using highly cohesive, silicone-gel filled anatomically placed breast implants was accrued. This single surgeon experience, used a standardized subfascial pocket dissection.  All cases were performed in a private office AAAA accredited surgical suite and prospectively followed over a one-year period.  Patients were given a standard preoperative consultation with regard to size and implant pocket placement.  Data was compiled with a standardized questionnaire including preoperative and postoperative BREAST-QTMAugmentation Module 1.0.  Reasons for choosing the subfascial position, implant size, and implant position were recorded in open answer format. These were given at the preoperative consultation as well as the three-month postoperative follow up visit. Results were followed by questionnaire as well as consecutive case review. 

Results/Complications:

Common reasons for implant position included doctor recommendations, desire for achieving a lift without a mastopexy, and a more natural feel.   Anatomic shaped implants were chosen based on the desire for a more natural shape and feel, along with achieving a lift without an actual mastopexy.  In follow up, there were no instances of capsular contracture, implant malposition, implant malrotation, infection, or reoperations.  Patients were satisfied with both the feel as well as the projection.  In particular, they were pleased with the ability of lifting the breast parenchyma without an addition of a mastopexy.

Conclusion:

Subfascial placement of highly cohesive silicone gel filled anatomically shaped breast implants is a safe and effective technique of breast augmentation offering benefits found from prior studies of both anatomic shaped cohesive gel implants as well as the subfascial position.  An added benefit is that of improved projection and satisfaction in those patients desiring a breast lift without the added morbidity of a mastopexy. 

 

  1. Lista F, Tutino R, Khan A, Ahmad, J.  Subglandular Breast Augmentation with Textured, Anatomic, Cohesive Silicone Implants:  A Review of 440 Consecutive Patients.  Plas. Reconstr. Surg. 132:295, 2013.
  2. Heden P, Bone B, Murphy D, Slicton A, Walker P.  Style 410 Cohesive Silicone Breast Implants:  Safety and Effectiveness at 5-9 Years after Implantation.  Plast. Reconstr. Surg.  118: 1281, 2006.
  3. Weum S, Weerd L, Kristiansen B.  Form Stability of the Style 410 Anatomically Shaped Cohesive Silicone Gel-Filled Breast Implant in Subglandular Breast Augmentation Evaluated with Magnetic Resonance Imaging.  Plast. Reconstr. Surg.  127:409, 2011.
  4. Jewell M, Jewell J.  A Comparison of Outcomes Involving Highly Cohesive, Form-Stable Breast Implants From Two Manufacturers in Patients Undergoing Primary Breast Augmentation.  Aesthetic Surgery Journal.  30 (1) 51. 
  5. Stevens WG, Hirch EM, Tenenbaum MJ, Acevedo M.  A Prospective Study of 708 Form-Stable Silicone Gel Breast Implants.  Aesthetic Surgery Journal.  30(5) 693.
  6. Maxwell GP, Van Natta BW, Murphy DK, Slicton A, Bengston BP.  Natrelle Style 410 From-Stable Silicone Breast Implants:  Core Study Results at 6 Years.  Aesthetic Surgery Journal.  32(6) 709. 
  7. Brown MH, Shenker R, Silver SA.  Cohesive Silicone Gel Breast Implants in Aesthetic and Reconstructive Breast Surgery.  Plast Reconstr Surg.   2005; 116:768.
  8. Panettiere P, Marchetti L, Accorsi D.  Soft Cohesive Silicone Gel Breast Prothesis:  A Comparative Prospective Study of Aesthetic Results Versus Lower Cohesivity Silicone Gel Prostheses.  J Plast Reconstr Aesthet Surg.  2007; 60:482.
  9. Graf RM, Bernardes A, Rippel R, et al.  Subfascial Breast Implant:  A New Procedure.  Plast. Reconstr. Surg.  111:904, 2003.

     10. Barbato C, Pena M, Triana C, et al.  Augmentation Mammoplasty Using the Retrofascia Approach.  Aesthetic Plast. Surg.      26:  148, 2004.

     11. Hunstad JP, Webb LS.  Subfascial Breast Augmentation:  A Comprehensive Experience.  Aesthetic Plastic Surgery.  2010. 34: 365.

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