Subfascial Breast Augmentation in Miami
Dr. Maercks’ COLD-SUBFASCIAL breast augmentation is a unique procedure that he developed after attaining diverse international experience and striving to provide the most beautiful, natural appearing and longest lasting breast augmentation for his patients. Dr. Maercks’ technique is unlike the most commonly used techniques in several ways. Usually breast implants are placed under the pectoralis major muscle using a technique commonly referred to as submuscular or ‘dual-plane.’ The implant is covered partially by the muscle and partially by just breast tissue and skin. There are several consequences including a tendency to ride in a high unnatural position, accelerated aging of the lower pole of the breasts tissue and skin and perhaps most unfortunate, a bizarre unaesthetic lateral movement of the implants with arm motion. Imagine being at the beach in a bikini and enthusiastically talking with hand motions, these movements inside the bikini can be disturbingly distracting!
Dr. Maercks learned the merits of subfascial placement of breast implants from the internationally renowned Dr. Ruth Graf. By combining subfascial placement with a transaxillary approach the breast tissue is never entered and is left continuously supported by a very strong connective tissue layer called fascia. There are several advantages of this technique including a beautiful redraping of breast tissue over the top of the implant making the implant less noticeable, giving the breast a very natural appearance. Even better, the fascia acts like a support bra inside the breast, taking the load of the implant and protecting the breast tissues from the forces of gravity which can quickly age other techniques.
After recognizing the value of the pectoral fascia, Dr. Maercks sought out a technique to maximally support the integrity and power of this structure. He changed the procedure from one that used electrocautery for dissection to one using cold dissection. Electrocautery devices which are universally used in breast surgery such as augmentation burns the adjacent tissues and can cause local tissue death/necrosis. For this reason Dr. Maercks avoids electrocautery in his COLD-SUBFASCIAL technique. The entire dissection is completed using precise sharp dissection under direct visualization. What this means is that the maximal amount of strong supportive fascia is elevated while producing zero thermal damage! The end result, a continuous supportive brassiere with a precise design for the most beautiful feminine form.
Extended fascial preserving subfascial breast augmentation and revision without electrocautery a novel techinique providing uniquely supported control of the breast shape and aesthetic appearance.
The subfascial plane in the breast augmentation has gained recent support in mainstream literature with supports claiming merits of more natural shape, better support and longevity of the result. The problems resulting from pectoral muscular movements are reduced or eliminated and better control is achieved medially and laterally to occupy the true “footprint” of the breast. The thin but strong mm layer is perhaps the most debated structure in breast augmentation surgery. Presented is a novel technique intended to optimize the benefits of the subfascial plane by eliminating electrothermal damage, maintaining a completely contiguous extended fascial envelope, maintaining direct visualization to control breast shape through creation of a custom fascial brassiere.
Subcutaneous tunnel and fascial plane of the intended breast shape is infiltrated with tumescent solution containing 1:250,000 epinephrine and Marcaine 2.5g/kg. The entire procedure is completed under direct visualization with fiber optic lighted retractors and 13” curved Metzenbaum scissors and scalpel through the transaxillary approach unless mastopexy access is indicated. Contiguous fascial envelope is continued into serratus fascia and inferiorly as indicated. Submuscular revisions converted to a “neosubfascial plane.” Only low-profile or lowest profile anatomic shapes are used in the technique with a general preference for Allergan style 410 FM, Style 10 or Sientra classic oval implants. Placement of the implants is assisted by use of a funnel.
The cold technique and direct observation allow dissection of a full strength, custom shaped fascial “brassier.” A naturally draped form is produced that the author has been unable to attain with other techniques such as subglandular, subpectoral, and dual-plane. Interoperative endoscopic evaluation reveals a true wheat fascia that is load bearing. The projection attained with low profile implants demonstrates that the fascia, not the implant is responsible for breast shaping.
To learn more about cold sub-fascial breast augmentation and what it can mean for you, schedule a consultation with the Maercks Institute today.