With breast reductions, lifts, and implant removals on the rise—and the human form generally shrinking before our eyes, courtesy of Ozempic and Co.—one might question the status of the classic “boob job,” a procedure that unapologetically endows. Despite its inherent largesse and controversial nature, breast augmentation remains the most popular cosmetic surgery among women worldwide (and ranks number two in the U.S., with over 300,000 takers in 2023, according to the American Society of Plastic Surgeons). And the operation has evolved in recent years. The changes, breast specialists say, are largely driven by savvy patients, who are challenging old ideas about implants and advocating for the outcomes they want—right down to the surgical maneuvers used to achieve them.
Generating buzz across the internet is the reprisal of a decades-old technique that places implants on top of the chest muscle instead of under it, as has been customary for the past 20 years. (You may have seen surgeons on social talking about “subfascial” breast augmentation. This is usually what they’re referring to: tucking implants underneath the fascia, the connective tissue overlying the pectoralis muscle.) While there are benefits and drawbacks to both methods of augmentation, some surgeons are bucking below-the-muscle convention for a placement that, they believe, creates the most natural effect while ensuring the breasts move in a way that looks and feels normal.
There’s no perfect option—there’s just options and you have to figure out what fits best into your life.
That last part is crucial, but often overlooked, says board-certified Beverly Hills plastic surgeon Kelly Killeen, MD. In her experience, surgeons tend to focus too much on how results look in static photos while failing to consider that a breast which appears “natural” in an after picture may move unnaturally in real life. “As someone who had implants under the muscle, I can tell you, it feels weird, it’s not natural, and it makes a lot of women uncomfortable,” says Dr. Killeen. She started performing subfascial augmentations almost exclusively about two years ago, as more patients began requesting them, often after learning about the technique from surgeons and fellow patients on social media.Women are choosing implants that fit their frame, lifestyle, and overall aesthetic. Those in Beverly Hills are asking for “subtle, pretty, proportionate breasts,” à la Miley Cyrus, Bella Hadid, or Taylor Swift, according to Dr. Killeen. “They don’t want a bolt-on,” she says. “They just want to fit in their clothing better and [for their implants to] not be noticed.”“You pick your poison with breast augmentation,” summarizes Dr. Killeen. There are potential issues no matter where you place an implant. While she believes most people are candidates for the subfascial approach, she acknowledges that “any time you put an implant over the muscle, there’s always a possibility of that upper edge being visible, especially in thinner people.” That said, she adds, when you go under the muscle in someone slim, muscle movement becomes more obvious. Ultimately, “there’s no perfect option—there’s just options and you have to figure out what fits best into your life.”More crucial than implant position, notes Dr. Teitelbaum, is the size of the implant relative to one’s tissues. Dr. Killeen agrees: “Disproportionate implants are associated with more troubles, no matter where you put them.” When it comes to technique, she advises finding a surgeon you trust and heeding their advice, “because they’ll get the best results if they’re doing what they’re best at.”Read the full article on Allure.
