Subfascial Breast Augmentation: A Systematic Review and Meta-Analysis of Capsular Contracture

Abstract

Background: Subfascial breast augmentation is a technique originally developed to reduce the risks of capsular contrac-ture while decreasing the postoperative pain associated with subpectoral augmentation. It was pioneered in Brazil by Dr. Graf and others, and recently this technique has gained interest in the aesthetic world. Objectives: The goal of this study was to provide a systematic analysis of subfascial breast augmentation to assess the combined reported rates of capsular contracture, animation deformity and complications. Methods: The PubMed, Embase, and Web of Science databases were searched for the use of the subfascial plane for breast augmentation. We included studies that reported on capsular contracture and other outcomes following subfascial breast augmentation. Results: Through the initial search, 26 articles were identified. Of which, 22 were included in the final study. A total of 3743 patients were identified across these studies with a total number of 38 cases of capsular contracture representing a rate of 1.01% of capsular contracture. Several articles reported on demographics, perioperative and long-term complications , and outcomes with regards to the aesthetic outcome from the surgeon's perspective. Several infections were reported representing a rate of 0.1%. Animation deformity was not reported, although rippling was occasionally reported as was malrotation, axillary banding, sensory deficit, and asymmetry. Subfascial breast augmentation appears to have a low complication rate and an extremely low rate of capsular contracture at approximately 1%. Conclusions: Subfascial breast augmentation may provide the benefits of low rates of capsular contracture while avoiding the discomfort and future animation deformity of subpectoral augmentation. Subfascial breast augmentation utilized placement of the breast implant below the prepectoral fascia and above the pectoral muscle through either an inframammary, transaxillary, or periareolar incision. 1-4 The technique was developed to combine the benefits of the subfascial plane including decreased rates of capsular contracture and blunting of the implant edges and the creation of an ana-tomic pocket for precise implant placement while reducing the pain from submuscular pocket dissection as well as animation deformity. 5-7 Subfascial augmentation has been previously recommended for thin or athletic patients, as