title: Subfascial breast augmentation: a comprehensive experience.
abstract: BACKGROUND
  Subfascial breast augmentation, first performed by Dr. Ruth Graf in 1998, places the implant above the pectoralis muscle but below the pectoralis fascia. Graf documented that this approach resulted in less capsular contracture than subglandular implant placement and a more natural shape while eliminating implant animation with arm movement. In addition, implant edge visibility was decreased compared with subglandular implantation in all but the extremely thin patient. Because of the described benefits and high patient satisfaction, the authors began to perform this technique in 2006.
  
  
  METHODS
  This report presents a comprehensive review of the aforementioned technique by describing a large series of subfascial augmentations (inframammary, periareolar, and endoscopic transaxillary) as primary procedures, secondary procedures, and operations with concurrent use of mastopexy performed by a single surgeon using multiple approaches. A patient satisfaction questionnaire was used in addition to a detailed clinical assessment.
  
  
  RESULTS
  The results of this procedure were reproducible, controllable, and predictable. The study demonstrated a high degree of patient and surgeon satisfaction with few complications, a low rate of capsular contracture, no evidence of breast animation with arm movement, excellent lower pole coverage, and a brief recovery period.
  
  
  CONCLUSIONS
  Subfascial breast augmentation is a safe, effective procedure allowing for predictable results with excellent shape and longevity. For the properly selected patient, this approach provides the benefits of subglandular and submuscular placement without the disadvantages associated with each.
authors.affiliation: The Hunstad Center for Cosmetic Surgery, PA, 11208 Statesville Road, Huntersville, NC 28078, USA. jphunstad@gmail.com
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Hunstad
authors.forename: L Shayne
authors.initials: LS
authors.lastname: Webb
mesh_terms: D000328:Adult; D018427:Breast Implants; D005205:Fascia; D005260:Female; D006801:Humans; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires