A modified subfascial breast augmentation, called Cold-Subfascial Breast Augmentation, avoids negative cosmetic effects from muscular animation, motion and shape change caused by arm motions and lateral displacement, or bottoming out caused by pectoral activation, says Miami, Fla., based plastic surgeon Rian A. Maercks, M.D., who owns the trademark on the procedure.
What’s different? Dr. Maercks tells The Aesthetic Channel that he doesn’t use electrocautery or blunt dissection.
“The pectoral fascia is a very thin layer, and it’s strong if it’s kept intact. But if you use blunt dissection, you can delaminate the structure. And if you use electrocautery, you vaporize much of it and cause apoptosis, or programed tissue death,” he says.
Dr. Maercks has modified subfascial breast augmentation, by using only cold technique — a scalpel or sharp scissors.
“By directly visualizing the dissection and doing a sharp dissection, I’m able to divide the muscular-fascial interface, preserving all the fascia,” he says. “Because it’s preserved, I have structural support to not only support the breast, to help prevent bottoming out from lateral displacement, but also to shape the breast.”
Dr. Maercks performs the procedure by accessing the interface of the pectoral fascia and pectoralis major muscle through the axilla. After careful dissection of the fascia from the muscle, he places the implant under the fascia, above the muscle.
Dr. Maercks says he uses the fascia to mold the breast in a more tear-drop shape.
With the Cold-subfascial approach, if Dr. Maercks uses a low-fill round implant, he gets an anatomic-shape just as he would using an anatomic implant.
“So, the fascia participates a lot in the shaping and the aesthetic outcome of the breast,” the plastic surgeon says.
Anyone who is a good candidate for breast augmentation, would be a candidate for the Cold-subfascial approach, according to Dr. Maercks.
“It’s a common thought that you cannot use the subfascial approach with very thin women, who have a low upper breast pinch test. But it works very well in these patients. The fascia helps shape the implant into an anatomic shape and also helps redistribute the breast tissue,” Dr. Maercks says.
Dr. Maercks says the largest implant he has placed doing this procedure is a 685 cc, and while he doesn’t believe there are limitations to how big an implant can be used, he doesn’t have experience using larger implants with the technique.