In this guide14 sections
- Key Points
- What Does Subfascial Mean in Breast Augmentation?
- Subfascial vs Subglandular vs Submuscular vs Dual Plane: What Is the Difference?
- What Are the Benefits of Subfascial Breast Augmentation?
- Does Subfascial Placement Reduce Capsular Contracture? What the Research Shows
- What Are the Disadvantages and Risks of Subfascial Breast Augmentation?
- Who Is a Good Candidate for Subfascial Breast Augmentation?
- How Is Subfascial Breast Augmentation Performed?
- Subfascial Breast Augmentation Recovery: What to Expect
- Can You Change From Under the Muscle to Subfascial?
- What Happens at a Subfascial Breast Augmentation Consultation in London?
- Frequently Asked Questions
- Subfascial Breast Augmentation in London
- References
Key Points
- What is subfascial breast augmentation? A breast implant placed beneath the thin sheet of connective tissue (the pectoral fascia) that covers the chest muscle, but on top of the muscle itself. The muscle is not cut or lifted.
- How it differs from other placements: subglandular implants sit above the fascia, submuscular and dual plane implants sit wholly or partly beneath the muscle. Subfascial sits between the two.
- Why surgeons use it: it avoids the muscle-related drawbacks of under-the-muscle placement, including animation deformity, while adding a layer of coverage that softens the implant edge.
- What the evidence shows: a pooled analysis of 22 studies found capsular contracture in about 1% of patients[1], and a 2024 meta-analysis favoured subfascial over subglandular placement, although the underlying studies were small and at high risk of bias[2].
- It does not suit everyone. The fascia is thin, so patients with very little breast tissue or skin coverage may need muscle coverage, and sagging breasts may need a lift.
- The decision is made at consultation, after your surgeon examines your breast tissue, skin and chest wall.
Subfascial breast augmentation describes where the implant is positioned, not a different kind of implant. Patients searching for subfascial implants or sub fascia implants are usually comparing it with the two placements they hear about most: over the muscle versus under the muscle breast implants. Subfascial placement is a third option that sits between them, and it has become far more widely discussed over the last decade.
This guide explains what subfascial means in breast augmentation, how it compares with subglandular, submuscular and dual plane placement, what the research says, the risks, who it suits and what recovery involves. It is written to answer the question “what is subfascial breast augmentation?”; if you already have under-the-muscle implants and are wondering about moving them, our separate guide to changing implant placement from under the muscle to subfascial covers that operation. For the wider procedure, see our breast augmentation page.
What Does Subfascial Mean in Breast Augmentation?
Sub means beneath and fascial refers to fascia, so subfascial means beneath the fascia. The fascia in question is the pectoral fascia, a thin, tough, membrane-like layer of connective tissue that lies over the pectoralis major, the large fan-shaped chest muscle behind the breast. In a subfascial breast augmentation the surgeon makes a pocket by gently lifting this fascia away from the muscle, places the implant in that pocket, and leaves the muscle attached to the ribs and breastbone.
The technique is usually credited to the Brazilian surgeon Ruth Graf, who first performed it in 1998, as a way of getting a more natural shape and fewer capsular contractures than subglandular placement without the pain and movement of under-the-muscle implants[6]. You may also see it written as “sub fascial”, “subfacial” or “subfascial plane”.
Subfascial vs Subglandular vs Submuscular vs Dual Plane: What Is the Difference?
Breast implants can be placed in four planes, and the terms are often confused. They describe how many layers of your own tissue lie in front of the implant.
- Subglandular (over the muscle): the implant sits directly behind the breast gland and in front of the fascia and muscle. It has the least tissue cover.
- Subfascial: the implant sits behind the fascia and in front of the muscle. It has the same position relative to the muscle as subglandular, with the fascia added as a cover.
- Submuscular (under the muscle): the implant sits wholly behind the pectoralis major.
- Dual plane: the upper part of the implant is behind the muscle and the lower part sits behind the breast tissue, after the muscle’s lower attachments are released.
Our guide to breast implant placement over and under the muscle compares these in more depth, and the breast implant options page covers the choices that sit alongside placement, such as shape and profile.
Is subfascial the same as over the muscle?
Partly. Subfascial implants are above the muscle, so patients often group them with over-the-muscle implants. The difference is the fascia. A subglandular implant sits in front of it, in direct contact with breast tissue; a subfascial implant sits behind it. Many surgeons regard that extra layer as helpful for edge visibility and capsule formation, although the evidence is not unanimous, as set out below.
Is subfascial the same as prepectoral?
Prepectoral is the term used mainly in breast reconstruction for an implant in front of the pectoral muscle, rather than behind it. A subfascial implant is also in front of the muscle, so the two overlap in position. Subfascial is the more specific term, because it also says the implant is behind the fascia. The related reconstruction question is covered in the FAQs below.
What Are the Benefits of Subfascial Breast Augmentation?
Surgeons who use the subfascial plane usually point to five advantages. They are reported in the literature, although not every one has been confirmed in high-quality trials.
No animation deformity
Animation deformity is the movement or distortion of an implant when the chest muscle is flexed. A 2019 systematic review found that some degree of it was reported in a median of 58% of patients after under-the-muscle placement, and that the degree seemed to rise with the amount of muscle involved[5]. With the muscle left intact in a subfascial augmentation, the implant is not pushed around when you tense your chest, which matters particularly to people who lift weights, climb or do yoga.
Less pain after surgery
When the muscle is raised from the ribs, the chest can feel tight and sore for days. Leaving it in place usually means a gentler early recovery. Our guide to whether breast augmentation is painful explains the pattern of discomfort you can expect with any placement.
A softer implant edge
The fascia adds a thin layer of coverage over the upper and inner edge of the implant, which can make the transition from chest to breast look more gradual. It is a modest layer, so it helps less in very slim patients. If rippling worries you, see our guide to breast implant rippling.
Faster settling: do subfascial implants drop and fluff?
Yes, they settle, but typically sooner than implants under the muscle. Under-the-muscle implants sit high at first because the muscle is pressing down on them, and take months to descend. A subfascial implant has no muscle over it, so it begins closer to its final position. The final shape still develops over about three to six months as swelling falls and the pocket softens; our guide to drop and fluff after breast augmentation gives the timeline.
A natural look and feel
With the implant in front of the muscle, it sits at the same depth as breast tissue and can look and feel closer to the breast itself. The overall outcome depends far more on implant size, profile and base width than on the plane alone; see our guides to breast implant sizes and implant profile and projection, and to getting natural looking results with breast augmentation.
Does Subfascial Placement Reduce Capsular Contracture? What the Research Shows
The most important question patients ask about any placement is whether it lowers the risk of problems. The evidence for subfascial placement is encouraging but incomplete, and it is worth reading honestly.
- A 2020 systematic review and meta-analysis in Aesthetic Surgery Journal Open Forum ↗ pooled 22 studies and 3,743 patients. Capsular contracture occurred in about 1% of patients and infection in about 0.1%. Animation deformity was not reported in any of the studies[1].
- A 2024 systematic review and meta-analysis in Aesthetic Surgery Journal ↗ compared subfascial with subglandular placement across three randomised trials and seven cohort studies. Subfascial placement had lower rates of capsular contracture, haematoma and rippling, but every included study carried a high risk of bias, and the authors called for better randomised evidence[2].
- A 2021 randomised trial in Plastic and Reconstructive Surgery ↗ assigned each breast of 20 patients to a subfascial or subglandular pocket and followed them for five years. Independent surgeons rated contour and shape higher in the subfascial group, and MRI showed fewer implant folds[3].
Not every trial agrees. A separate double-blinded randomised study of 20 patients with 12 months of follow-up found no clinical difference between the two planes, and concluded that the choice could be made according to the surgeon’s experience[4]. The honest summary is that subfascial placement looks at least as good as subglandular placement and may be better, but the trials are small and the long-term data are limited. No placement removes the risk of capsular contracture, rupture and other implant risks, and implants are not lifetime devices.
What Are the Disadvantages and Risks of Subfascial Breast Augmentation?
Subfascial augmentation carries the general risks of any breast implant operation: bleeding and haematoma, infection, scarring, changes in nipple sensation, asymmetry, capsular contracture, implant rupture and the possibility of further surgery. Our guide to side effects after breast augmentation explains which symptoms are expected and which need a call to the clinic.
Some risks are specific to this plane:
- Thin coverage. The fascia is a thin membrane, not a muscle. In slim patients with little breast tissue, the implant edge can still be visible or palpable and rippling can occur.
- Technical demand. The fascia is thin and can be difficult to separate cleanly from the muscle, so the technique depends on the surgeon’s experience.
- Less support than muscle. The pocket relies on the fascia rather than on the chest muscle, so malposition and bottoming out are things your surgeon will plan to avoid through pocket size and implant choice.
- Limited long-term evidence. As above, most studies are small and many are single-surgeon series.
If an implant moves, rotates or changes shape after surgery, our guides to how to tell if a breast implant has moved and common breast implant problems explain what to look for.
Who Is a Good Candidate for Subfascial Breast Augmentation?
Subfascial placement tends to be considered for patients who:
- have enough natural breast tissue and skin to cover the implant, at least over its upper and inner edge;
- are active or athletic, and want to avoid animation deformity;
- want a smoother early recovery with less chest tightness;
- are having a moderate rather than very large increase in size.
Some surgeons use a pinch test of the upper breast to judge how much tissue is available. In one South Korean series of 62 thin patients, an upper-pole pinch below 2 cm was treated as an indication for submuscular placement, and the authors combined muscle with fascial flaps to cover the lower and outer implant[8]. A 2005 report in athletic and thin patients also used partial muscle flaps with a subfascial pocket to improve upper-pole coverage, and used the subfascial plane to correct breasts that distort with muscle movement[7]. Variations such as the subfascial mini-muscle release technique ↗, which was described in 178 patients and reported two grade III or IV contractures and twelve mild muscle-related deformities, show how surgeons adapt the plane to anatomy[9].
Subfascial placement may not suit you if you have very little breast or fat cover, thin skin or significant sagging. Where the nipple sits below the breast fold, an implant alone fills the breast without lifting it, and a breast lift, with or without implants, may be the right operation. Patients with a narrow, tight lower pole or tuberous breasts often need a different plan. Breast asymmetry is common and can be addressed at the same time; see breast asymmetry correction.
How Is Subfascial Breast Augmentation Performed?
At Centre for Surgery, breast augmentation is a day-case operation under TIVA (total intravenous anaesthesia) given by a consultant anaesthetist, and takes around 90 minutes. Our guide to anaesthesia for cosmetic surgery explains what TIVA is like. The steps for a subfascial pocket are:
- Incision. The surgeon makes a 3.5 to 5 cm incision, usually in the fold beneath the breast. Other approaches exist; see our guide to breast augmentation incisions.
- Creating the pocket. The surgeon finds the fascia over the pectoralis major and lifts it carefully off the muscle, keeping the muscle intact.
- Placing the implant. A silicone implant, chosen at consultation for your frame, is placed into the pocket under the fascia and positioned symmetrically.
- Closing. The layers are closed with dissolvable sutures and a surgical bra is fitted.
Some surgeons combine the subfascial plane with fat transfer for extra upper-pole softness, an approach described in a step-by-step guide to subfascial hybrid augmentation ↗[10]. We offer hybrid (composite) breast augmentation and fat transfer to the breasts as separate treatments, and your surgeon will explain whether they would add anything for you. See also our comparison of breast implants vs fat transfer.
Subfascial Breast Augmentation Recovery: What to Expect
Recovery follows the pattern of any implant-based augmentation, and your surgeon will give you written aftercare. Typical timeframes at Centre for Surgery are:
- Day of surgery: home the same day with a responsible adult for 24 hours.
- Days 7 to 10: wound check; most patients return to desk work and driving once comfortable and off strong pain relief.
- Weeks 1 to 6: wear the surgical bra continuously, avoid reaching and lifting above shoulder height, and build up walking and light lower body exercise from around week 3.
- Week 6: surgeon review, move to a sports bra and return to full exercise if you are healing well.
- Months 3 to 6: the implants settle into their final position and swelling resolves, while scars continue to fade for about a year.
Our full guide to breast augmentation recovery and aftercare sets out each stage, and support garments after breast surgery covers bras. As the chest muscle is not cut, many patients find the first week less tight than they expected, but everyone heals differently and you should follow your surgeon’s advice rather than a general timeline.
Can You Change From Under the Muscle to Subfascial?
Yes, in selected patients. People with under-the-muscle implants who notice their breasts distort when they flex sometimes ask for the implants to be moved in front of the muscle. It is a revision operation with its own risks, and it is not right for everyone, particularly where the overlying tissue is thin. Our dedicated guide to changing implant placement from under the muscle to subfascial explains who is suitable and what the surgery involves, and the breast implant replacement and revision page covers replacement surgery.
What Happens at a Subfascial Breast Augmentation Consultation in London?
Placement is one of several decisions your surgeon makes with you, alongside implant size, shape, profile and incision. At Centre for Surgery, your consultation is with a GMC-registered plastic surgeon at our CQC-regulated Baker Street hospital, and the surgeon who assesses you is the surgeon who operates. They will examine your breast tissue, skin quality, nipple position and chest wall, take measurements, and explain which planes suit your anatomy and why. They can also show you before and after photographs of patients with similar starting anatomy. Our guide to preparing for your breast augmentation consultation lists what to bring and ask, and our advice on choosing a surgeon for breast augmentation will help you compare options.
Costs are confirmed in writing after consultation rather than quoted in advance, and finance options are available; see finance options for details. We recommend a two-week cooling-off period between consent and surgery. If you are weighing up implants before committing, our guides to silicone vs saline breast implants and the age for breast augmentation may help, and you can see real results in our breast augmentation before and after photos.
Frequently Asked Questions
What is the difference between over and under the muscle breast augmentation?
Over the muscle (subglandular) places the implant behind the breast tissue but in front of the chest muscle. Under the muscle (submuscular) places it behind the muscle. Over-the-muscle implants avoid muscle-related movement and sit at a gentler position, but have less tissue cover. Under-the-muscle implants have more cover at the top but can distort when the muscle is flexed and take longer to settle. Subfascial is a variation of over the muscle, with the fascia as an extra layer.
Do subfascial implants drop and fluff?
Yes, but they usually settle sooner than implants under the muscle because there is no muscle pushing them upwards. Swelling still takes weeks to fall, and the final shape develops over roughly three to six months.
Is subfascial better than submuscular?
Neither is better for everyone. Subfascial avoids animation deformity and tends to be less painful early on, while submuscular gives more coverage in very slim patients. Your anatomy, activity level and the size you want decide which suits you.
What does subfascial mean in breast augmentation?
It means the implant is placed below the pectoral fascia, the thin membrane covering the chest muscle, and above the muscle itself. The muscle is not cut or detached.
Do you need to wear a bra with silicone implants?
After surgery you wear a surgical bra continuously for about six weeks, then move to a supportive sports bra at your six-week review. Long term, a comfortable, supportive bra is sensible, particularly for exercise, but your surgeon will advise you on timing for your own situation.
What is the difference between prepectoral and subpectoral implants in breast reconstruction?
Prepectoral implants sit in front of the pectoral muscle, and subpectoral implants sit behind it. In reconstruction, prepectoral placement avoids muscle movement and pain but depends on good skin cover. The same trade-offs apply to cosmetic augmentation.
Is breast augmentation the same as breast reconstruction?
No. Breast augmentation is a cosmetic operation to increase breast size or improve shape. Reconstruction rebuilds a breast after cancer surgery or other tissue loss and is often performed as part of NHS breast cancer care. Both can use implants.
Can I get my under-the-muscle implants moved to subfascial?
Sometimes. It is a revision operation that depends on how much tissue you have in front of the implant, the quality of the existing pocket and why you want the change. Your surgeon can assess this at consultation.
Subfascial Breast Augmentation in London
If you would like to know whether subfascial placement suits your anatomy, a consultation with one of our plastic surgeons will answer that. Find out more about breast augmentation at Centre for Surgery.
Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation
References
- Gould DJ, Shauly O, Ohanissian L, Stevens WG. Subfascial breast augmentation: a systematic review and meta-analysis of capsular contracture. Aesthetic Surgery Journal Open Forum 2020;2(1):ojaa006. doi:10.1093/asjof/ojaa006 ↗
- Yuan M, Kim P, Gallo L, Austin RE, Lista F, Ahmad J. Outcomes in subfascial versus subglandular planes in breast augmentation: a systematic review and meta-analysis. Aesthetic Surgery Journal 2024;44(9):NP639–NP644. doi:10.1093/asj/sjae118 ↗
- Graf RM, Maluf Junior I, de Paula DR, Ono MCC, Urban LABD, Freitas RS. Subfascial versus subglandular breast augmentation: a randomized prospective evaluation considering a 5-year follow-up. Plastic and Reconstructive Surgery 2021;148(4):760–770. doi:10.1097/PRS.0000000000008384 ↗
- Maluf Junior I, Graf RM, Ascenço ASK, et al. Is there a breast augmentation outcome difference between subfascial and subglandular implant placement? A prospective randomized double-blinded study. Aesthetic Plastic Surgery 2019;43(6):1429–1436. doi:10.1007/s00266-019-01465-8 ↗
- Dyrberg DL, Bille C, Gunnarsson GL, et al. Breast animation deformity. Archives of Plastic Surgery 2019;46(1):7–15. doi:10.5999/aps.2018.00479 ↗
- Hunstad JP, Webb LS. Subfascial breast augmentation: a comprehensive experience. Aesthetic Plastic Surgery 2010;34(3):365–373. doi:10.1007/s00266-009-9466-1 ↗
- Baxter RA. Subfascial breast augmentation: theme and variations. Aesthetic Surgery Journal 2005;25(5):447–453. doi:10.1016/j.asj.2005.07.006 ↗
- Lee JH, Lee PK, Oh DY, Rhie JW, Ahn ST. Subpectoral-subfascial breast augmentation for thin-skinned patients. Aesthetic Plastic Surgery 2012;36(1):115–121. doi:10.1007/s00266-011-9761-5 ↗
- Xia Z, Xie J, Zhang W, Wang X, Zheng Y, Zeng A. Subfascial mini-muscle release dual-plane technique: a modified procedure for breast augmentation. Plastic and Reconstructive Surgery 2025;155(1):51–62. doi:10.1097/PRS.0000000000011284 ↗
- Munhoz AM, Marques Neto AA, Maximiliano J. Subfascial axillary hybrid breast augmentation: technical highlights and step-by-step video guide. Plastic and Reconstructive Surgery 2023;152(2):264e–269e. doi:10.1097/PRS.0000000000010216 ↗
