Breast augmentation surgery is not all about placing an implant in each “pocket” to create a bigger bust size. Another equally important goal is to recreate the look of a youthful, “unoperated” breast through the use of highly individualized techniques that respect the patient’s underlying anatomy.
Augmenting the breasts without resolving an existing ptosis or saggy appearance more often than not leads to poor results. However, some patients with pseudo or slight ptosis in which the nipple-areola complex has not yet fallen below the inframammary fold (or breast crease) can do without breast lift as long as the right surgical techniques are used.
One common technique used by Los Angeles plastic surgeons for patients with slight ptosis is the subfascial implant placement in which the prosthesis is supported and covered by pectoral fascia, unhindered by the pectoralis major muscle.
Proponents suggest the technique has some lifting effect and at the same time allows the implants to drop in the most natural position because the pec muscle is out of the picture.
However, the subfascial technique is different from the subglandular or “over the muscle” implant placement, which is criticized for its high risk of rippling, palpability, and bottoming-out because only the breast tissue supports and carries the weight of implants.
The recently developed technique is also way different from the submuscular or “under the muscle” implant placement, which reduces palpability and implant rippling, but poses risk of breast animation especially in patients with a well-developed pec muscle (e.g., athletes and bodybuilders).
Proponents of subfascial believe that it eliminates the risk of breast animation linked to submuscular and at the same time provides a good amount of coverage and support unlike the subglandular technique. Despite being thin, the pectoralis fascia is a strong structure that can be separated from the thick pectoralis muscle.
They also suggest that the strong fascia, with the thick pec muscle out of the picture, allows the breast implants to “drop” in the most natural position, leading to a somewhat teardrop shape, which is an archetype of a youthful, “unoperated” breast.
But to prevent the slight ptosis from worsening, Los Angeles plastic surgeons always emphasize the importance of choosing a smaller or conservative-sized implant. The goal is to minimize skin thinning and “stress” on the breast tissue.
Another possible approach to correct minimal ptosis is to use a teardrop-shaped gummy bear [fifth generation silicone] breast implant that is said to slightly push the breast tissue up.