Subfascial breast augmentation: theme and variations.

BACKGROUND Subfascial placement of breast implants for augmentation has been advocated as an option that has some of the advantages of both the subpectoral and subglandular approaches while minimizing the disadvantages of each. OBJECTIVE The author reports on the use of the subfascial approach in athletic and thin individuals, including extension of the range of applications for this approach through the use of partial muscle flaps for upper pole coverage. METHODS A periareolar approach was preferred, particularly when segmental muscular flaps were incorporated into the augmentation. Medially-based flaps supplied by the intercostal perforators were used to achieve greater upper-pole coverage, which can be particularly beneficial when using high-profile implants. Conversion from dual-plane submuscular to subfascial placement was used for correction of a "dynamic" breast (a breast that is distorted with muscle activity) or related contour deformity. RESULTS Examples of the range of applications of the subfascial approach are presented, including use of small and larger segmented muscle flaps and correction of the dynamic breast or contour deformity. CONCLUSIONS Use of the subfascial approach, with selective application of segmented muscle flaps, can help reduce reoperation rates after breast augmentation.