Donna is a 30-year-old female with one child. She is 5’7”, athletic and at 130 pounds would be considered as low body-fat. She had been to two reputable and board certified plastic surgeons who both recommended gel implants in the subpectoral position (under the chest muscle) combined with a lift procedure (mastopexy) which would correct her mild sag that developed after breast feeding her daughter. The problem was that since she was divorced, she didn’t want any extra scars on her breasts. Her third consultation was also with a board certified plastic surgeon she liked his operative plan better. He told her about the subfascial position for the implants.
Although still infrequently done in the United States, this procedure was first described in 1998 by Dr. Ruth Graf, a professor of plastic surgery from Sao Paolo University in Brazil. This procedure places the implant on top of the muscle but below the outer covering of the muscle called fascia. When combined with the state-of-the-art cohesive gel implants, the subfascial placement offers protection from the wrinkles and visible edges that are a risk for low body fat individuals. By being on top of the muscle the subfascial position can re-inflate the breast and correct mild sagging (ptosis) better then the subpectoral position. In many cases of mild ptosis the procedure eliminates the need for a second procedure (lift) with extra scarring.